Amid intense scrutiny of 2020 Presidential election results, little attention has been paid to health-related state ballot initiatives. While COVID-19 limited citizens’ ability to collect signatures to get questions on the ballot, citizens and legislatures in nine states placed health care-related issues on their state ballots.
This chart provides the status of each referendum, but one theme is of particular interest to states confronting deep budget challenges – the emergence of new taxes and fees to support health and other programs.
Tobacco taxes: Colorado and Oregon increased taxes on tobacco and nicotine products and will use the revenues for health and education, mental health services, tribal health, tobacco education and related services, and as general funds. Taxes on tobacco, e-cigarettes, and other nicotine products have been used as a public health strategy to disincentivize tobacco use and as a source of revenue. States monitor tax rates on tobacco products in their neighboring states, as increases in one state can sometimes motivate action in others. (View a 2020 State Cigarette Excise Tax Rates and Rankings chart.) Currently, the average tax on a pack of cigarettes is $1.82 with a high of $4.50 in Washington, DC and a low of 37 cents in Georgia. Oregon’s recently enacted measure will increase its tax to $3.33 per pack, and Colorado’s measure will increase its tax to $2.64 per pack.
View a chart detailing health-related ballot initiatives that went before voters in nine states here.
In Oklahoma, voters rejected a proposal to divert a portion of the state’s tobacco settlement dollars to help fund Oklahoma’s recent Medicaid expansion, which was recently enacted following a successful citizen referendum.
Marijuana initiatives: Three states – Mississippi, South Dakota, and Louisiana – joined the 33 states that have legalized medical marijuana, and Arizona joined the 11 states that allow recreational marijuana. Arizona’s marijuana sales revenues will support community colleges, municipal services, highways, and a new Justice Reinvestment Fund. Oregon has legalized psilocybin mushrooms and will use revenues to support drug treatment and community recovery centers.
Family leave: In Colorado, voters enacted a paid family leave law, funded by payroll taxes of employers and employees.
While 2020 had fewer state ballot questions, policymakers will note the re-emergence of taxes on tobacco and marijuana sales that may signal strategies for budget deliberations to come.
