Straight to the People

November 3, 2020

Photo by Diane Yee licensed under CC BY-NC-ND 2.0

From restricting abortion to legalizing marijuana, voters are weighing in on a variety of significant state health policy questions this election. 

Listen to the full episode below, read the transcript and scroll down for more information.

Click here for more of our coverage of health care and the 2020 election.

NOTE: An earlier version of this episode said Washington D.C. was considering “decriminalizing” psychoactive plants like mushrooms. They were in fact only considering effectively decriminalizing them — by directing police to make enforcing laws related to this issue a low priority.

States with Health-Related Ballot Measures

The 2020 election has massive stakes, including for national health policies like the ACA and our response to COVID-19. Some states will also be voting directly on some interesting (and often contentious) health policy issues through ballot initiatives.

With help from Ballotpedia and the National Conference of State Legislatures (NCSL), we count 11 states, plus Washington, DC (in orange on the map), with health-related measures on their ballots. NCSL reports that, in general, the total number of ballot measures (124) this year is lower than usual, likely due to COVID-19 impeding the signature gathering process required for citizens to get initiatives on the ballot.

What's on the Ballot?

Among these 17 health-related measures, the most common topic by far is the taxation and legalization of substances, including tobacco, marijuana and mushrooms. For more on the details and tradeoffs of those drug-related proposals, listen to our full episode featuring University of Maryland law professor Kathi Hoke.

Abortion Access

Colorado: Proposition 115 bans abortion after 22 weeks unless required to save the mother’s life.

Louisiana: Amendment 1 adds language to the state’s constitution declaring that “nothing in this constitution shall be construed to secure or protect a right to abortion or require the funding of abortion.”

Cigarettes and Vapes

Colorado: Proposition EE increases cigarette taxes, imposes a new tax on e-cigarettes (also known as vapes) and allocates the revenues for health and education programs.

Oklahoma: State Question 814 shifts how the state’s tobacco settlement money is spent, in part, to help fund Medicaid. 

Oregon: Measure 108 increases cigarette taxes, imposes a new tax on e-cigarettes (also known as vapes) and allocates the revenues for health programs.

Dialysis Clinic Regulations

California: Proposition 23 requires dialysis clinics to have at least one licensed physician on site while patients are being treated and imposes new reporting requirements.

Long-Term Care

Washington: Engrossed Senate Joint Resolution No. 8212 amends the constitution to allow the state to invest long-term care trust fund money in the stock market.

Marijuana Legalization

Arizona: Prop 207 legalizes and taxes recreational marijuana use for adults 21 years and older. It also allows people to petition for the removal of marijuana-related crime convictions from their records.

Mississippi: Ballot Measure 1 proposes two alternate approaches to legalizing marijuana for medical use. 

Montana: Initiative 190 and Constitutional Initiative 118 combine to legalize and tax recreational marijuana use for adults 21 years and older. Initiative 190 also allows people convicted of marijuana-related crimes to petition for re-sentencing or removal of the conviction from their records.

New Jersey: Public Question 1 legalizes and taxes recreational marijuana use for adults 21 years and older.

South Dakota: Constitutional Amendment A and Measure 26 combine to legalize marijuana for recreational use for adults 21 years and older and for medical uses.

Paid Medical Leave

Colorado: Proposition 118 establishes a state program providing at least 12 weeks of paid family and medical leave funded by a payroll tax. 


Washington D.C: Initiative 81 directs police to de-prioritize the enforcement of laws related to psychoactive plants such as mushrooms.

Oregon: Measure 109 directs the Oregon Health Authority to develop a program for legally administering psilocybin-producing products such as mushrooms.

Sex Education

Washington: Referendum 90 implements Senate Bill 5395 requiring students in grades 6-12 receive comprehensive sex education.

Stem Cell Research

California: Proposition 14 issues $5.5 billion in bonds to fund stem cell research projects and governance changes at the California Institute for Regenerative Medicine.

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Episode Resources

Select Reporting on 2020 State Ballot Measures:

Ballot Measures: A National Rundown for 2020 (Louis Jacobson, University of Virginia Center for Politics, 10/27/2020)

In the Pandemic, a Shifting Ballot Debate on Legalizing Drugs (Kirk Johnson, New York Times, 10/26/2020)

2020’s marijuana legalization ballot measures, explained (German Lopez, Vox, 10/16/2020)

Women’s Health on the Ballot (Michelle Long, KFF, 10/15/2020)

State Elections 2020: Health Ballot Measures (Kate Bradford, NCSL, 10/12/2020)

Episode Credits


Kathleen Hoke, JD, Professor, University of Maryland Carey School of Law; Director, Network for Public Health Law Eastern Region 

The Tradeoffs theme song was composed by Ty Citerman, with additional music this episode from Blue Dot Sessions.

This episode was reported and produced by Leslie Walker. It was mixed by Andrew Parrella.

Additional thanks to:

Trish Riley, the Tradeoffs Advisory Board and our stellar staff!