On Election Day 2008, voters across the country voted for or against 153 ballot initiatives on issues specific to their states. Of the fewer than 20 ballot initiatives related to health care, three were related specifically to health system reform. (For information about other health-related ballot initiatives including those related to medical marijuana, abortion, long-term care, bonds for financing health care services, and other issues see: http://www.ncsl.org/programs/legismgt/elect/dbintro.htm.)
The three state ballot initiatives related to health system reform—in Montana, Arizona, and Maine—do not seem to indicate a national trend toward or away from any particular type of health reform strategy. Montana voters supported expansion and coordination of publicly funded children's health coverage, while Arizona voters narrowly rejected a state Constitutional amendment that would have prohibited an individual or employer mandate or a single-payer system. Both of these referenda suggest support for state initiatives to expand coverage. Maine voters, on the other hand, rejected replacing the current funding mechanism for the Dirigo Health Plan—which provides subsidized coverage to small firms and low-income workers and their families—with a new, potentially more stable financing method. It is likely, however, that the Maine vote expressed the public's rejection of new taxes during difficult economic times rather than support for or against the Dirigo health program.
Below we describe these three 2008 ballot initiatives in more detail.
References [1] Montana SCHIP enrollment was 17,240 and Medicaid enrollment for children was 46,645 in November 2008. Approximately 31,000 (14%) of all Montana children are uninsured according the 2008 U.S. Census Bureau Current Population Survey, based on the three-year average (collected 2006-2008).
[2] The eligibility cut-off between Medicaid and SCHIP will depend in part on the details of the SCHIP reauthorization by the U.S. Congress, expected in early 2009.
[3] The SCHIP expansion applies only to children not covered by private insurance for at least three months, ineligible for Medicaid, and who are U.S. citizens or qualified aliens and state residents. The plan stipulates that eligibility may be reduced if funding is insufficient.
[4] Enrollment is frozen, except for new dependents for existing members, new workers for currently participating employers, and applicants who do not need subsidies. About 11,000 members and 621 small groups are currently enrolled.
[5] 64.3% of referendum voters chose "Yes" to veto Public Law 629, legislation enacted in June 2008 that amended the Dirigo Health Program statute to replace the Savings Offset Payment with funding from 1) a health access surcharge of 1.8% on paid insurance claims; 2) an increase in excise tax on malt beverages and wine; and 3) a new tax on syrup for soft drinks and bottled soft drinks. According to Riley, the legislation reflected a compromise developed over four years of negotiations.