Abortion rights has dominated the headlines this election cycle and will be directly decided in several states next week. But voters in more than a half-dozen states will also have a chance to weigh in on several other health care-related ballot measures.
Here’s a look at some of the health care questions beyond access to reproductive care that some voters will see on their ballots:
Medicaid: Voters in South Dakota will decide whether to amend the state constitution to add a work requirement to the state’s Medicaid program. The Republican-led state legislature referred the question to the ballot after voters bypassed the legislature to expand Medicaid through a 2022 ballot measure.
But even if voters sign off on the work requirement, it would require approval from the federal government, meaning its implementation will likely hinge on the presidential election.
Former President Donald Trump encouraged and approved applications for state work requirements while he was in office. Every application except Georgia’s was withdrawn by the states, blocked by the courts or revoked by the Biden administration.
Several GOP-controlled state legislatures have shown interest in trying again if Trump is re-elected. A successful vote on the ballot measure would put South Dakota first in line.
The vote in South Dakota is also notable because it’s the only ballot measure related to Medicaid expansion anywhere in the country.
From 2017 to 2022, seven states passed Medicaid expansion when it was on the ballot. Of the 10 remaining states that have not expanded Medicaid, only two — Florida and Wyoming — allow ballot initiatives.
Another ballot measure to watch is California’s Proposition 35, which would make an existing tax on managed health care plans permanent. If the state’s plan is approved by the federal government, the money would be put toward higher rates for doctors and other providers who accept MediCal, the state’s Medicaid program.
Supporters, including much of the state’s health care industry, have raised more than $50 million and say the move would incentivize more providers to accept MediCal. Opponents say it would do more harm than good by taking away funding from some MediCal programs for the benefit of others.
Gov. Gavin Newsom (D), who opposes the measure, said it would hamstrung future legislators and governors’ ability to balance the budget.
Aid in dying: West Virginia is the first state to vote on changing the state constitution to prohibit medically assisted death. The ballot measure would prohibit “the practice of medically assisted suicide, euthanasia, or mercy killing of a person.”
Medically assisted dying is already illegal in West Virginia. But ballot measure supporters say a constitutional amendment would be a better safeguard.
“An important part of the pro-life movement is ensuring life is protected from conception to natural death,” Del. Chris Pritt (R) said this month.
Ten states allow physicians to prescribe lethal medications for terminally ill patients to self-administer. Legislation that would allow medical aid in dying made significant progress in several state legislatures in 2024, where advocates said it is a question of bodily autonomy on par with reproductive rights.
Delaware Gov. John Carney (D) vetoed a bill passed by the Democrat-controlled legislature. A bill in Maryland failed by one vote.
Fertility treatments: Illinois voters will weigh in on whether state officials should consider further expanding requirements for insurance coverage of fertility treatments, which can cost families tens of thousands of dollars.
The outcome won’t be legally binding, but it could inform lawmakers as they consider their policy positions in upcoming legislative sessions.
More than a dozen states considered bills in 2024 that would put the treatments in reach for more families. The issue gained prominence and became more politicized in the aftermath of the 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, which removed the constitutional right to an abortion, and a February ruling in Alabama that embryos created through in vitro fertilization should be afforded the same legal protections as children.
Illinois lawmakers have sought to increase the state’s already expansive requirements for IVF coverage. Under a bipartisan-backed law signed by Gov. JB Pritzker (D) in August, starting in January 2026 insurance companies must cover all treatments recommended by a doctor, rather than allowing health plans to stipulate that patients had to first try less costly treatments.
Firearms: A Colorado measure referred to the ballot by the state legislature would levy a 6.5% excise tax on firearms and ammunition to pay for crime victim services programs, mental and behavioral health programs for children and veterans, and school security and safety programs.
It would be one of the country’s first excise taxes on firearms and generate an estimated $39 million in revenue every year. The proposal is modeled after a new California law that imposes an 11% excise tax on all guns, ammunition and gun parts sold by licensed gun dealers.
Long-term care: Washington’s experiment with a long-term care program faces its biggest threat: a ballot initiative that would make voluntary the tax credit that pays for it. The Washington Cares program, enacted in 2019, provides qualifying residents up to $36,500, adjusted for inflation, to cover long-term care costs, financed by a payroll tax of 0.58%.
A yes vote on Initiative 2124 would allow employees and self-employed individuals to opt out of paying the payroll tax and receiving benefits under WA Cares. A fiscal impact statement that will appear in the voter guide estimates that, if the initiative is successful, it could cost the state millions to deal with the exodus of workers from the program.
WA Cares supporters say making the benefit voluntary would throw the program into a death spiral. Opponents of it say it is unfair to people who pay into it but might never get to use the benefit, that the coverage is inadequate, and that its future solvency is too uncertain.
The program has accumulated $1 billion in reserves since the collection of payroll taxes began in 2023 and is set to pay out its first benefits in July 2026. It’s been closely watched by other states looking to assist older residents with a major expense that is not covered by most public or private health insurance plans. New York, Massachusetts and California have authorized funding for actuarial feasibility studies.
Emergency declarations: Arizona voters will consider whether to curtail the governor’s powers during a state of emergency, a question that displays lingering political divisions over the response to the Covid-19 pandemic.
Proposition 135 would amend the state’s constitution to give the legislature the authority to terminate a state of emergency or alter the emergency powers granted to the governor, who would need permission from the legislature to extend emergency declarations beyond 30 days.
The amendment was referred to the ballot by the Republican-controlled legislature on a party-line vote. Arizona Republicans passed a law in 2022 that limited the amount of time the governor could declare a public health emergency without permission from the legislature.
Gov. Katie Hobbs (D), who was elected later that year, has not taken a public position on the latest attempt to curtail emergency powers.
Opponents say it could politicize the response to a disaster.