Health Care & Wellness
States Take Action on Upper Payment Limits to Address Prescription Drug Affordability
December 18, 2024 | Mary Kate Barnauskas
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Key Takeaways:
On November 5, 2024, voters in ten states will have the chance to decide the future of reproductive rights in their state. Abortion is currently undefeated on the ballot since Roe v. Wade was overturned in 2022. Since then, voters in Kansas, Kentucky, and Montana have rejected anti-abortion measures, and voters in California, Michigan, Vermont, and Ohio have approved measures to establish constitutional rights to abortion.
The ballot measures and their implications vary by state. The measures on the ballot in Arizona, Florida, Missouri, Nebraska, and South Dakota are the most significant as each of these states currently enforce an abortion ban at some point before fetal viability. Voters in Nebraska have two abortion-related ballot measures before them with one establishing abortion protections and the other banning abortion after the first trimester in the state constitution. If both measures are approved in Nebraska, the measure with the most votes will go into effect. Montana’s measure is also consequential as the right to abortion in the state is tied to the constitutional right to privacy, which has been challenged in recent years. While Colorado, Maryland, Nevada, and New York do not currently restrict abortion and have protections in state law, the ballot measures are still noteworthy as they would further cement reproductive rights and hinder the ability of lawmakers to overturn them in the future.
The Arizona ballot features Proposition 139, which amends the state constitution to include a fundamental right to an abortion. If passed, the state will be limited in interfering with such right before fetal viability and prohibited from penalizing a person for assisting an individual in obtaining an abortion. The measure also allows abortions to protect the life of health of a pregnant individual after fetal viability.
Abortion has been a topic of debate in Arizona this year. In April, the state supreme court ruled that a total abortion ban from 1864 could be enforced. Though it took several attempts, a repeal of the ban was passed through the Republican-led legislature and signed by Gov. Katie Hobbs (D) in May. Currently, a 15-week ban that was passed in 2022 is in effect.
In Colorado, residents will be voting on Amendment 89. If passed, the right to abortion would be recognized in the state constitution, and the government would be prohibited from interfering with that right. Additionally, the measure specifies that the government cannot prohibit health insurance coverage for abortion, and repeals a provision in the state constitution that prohibits the use of public funds for abortions. Colorado does require a 55% supermajority vote for the measure to pass.
Currently, abortion is legal in Colorado and in 2022 lawmakers enacted the Reproductive Health Equity Act, which established a fundamental right to make decisions about one’s reproductive health care in statute.
Voters in Florida will decide on Amendment 4, which proposes to amend the state constitution to prohibit government interference with abortion. Specifically, the amendment prohibits a law from restricting abortion before viability or when necessary to protect the patient’s health. Of note, the amendment clarifies that it does not change the legislature’s authority to require parental notification before a minor has an abortion, which is a constitutional provision enacted by voters in 2004. Additionally, Florida does require a supermajority of 60% of votes to approve constitutional amendments.
Abortion is currently illegal after six weeks under a law enacted in 2023 and put into effect earlier this year when the state supreme court reversed court precedent and ruled that the state’s previous 15-week ban was constitutional. The court’s ruling allowed the 6-week ban to go into effect 30 days after the decision on May 1, 2024.
Maryland lawmakers voted to put Question 1 on the 2024 ballot. If passed, the measure would enshrine the right to reproductive freedom in the state constitution and prohibit the state from denying such right. Abortion is legal in Maryland under a law passed by the legislature in 1991, which establishes that the state may not interfere with the decision of a woman to terminate a pregnancy before fetal viability. The law was challenged by a veto referendum to repeal the law in 1992, but voters decided in favor of upholding the law.
Voters in Missouri will consider Amendment 3 to establish a right to reproductive freedom in the state constitution. The measure specifies that the right to reproductive freedom includes making decisions related to birth control and abortion care and prohibits the government from interfering with such rights. The measure does allow the general assembly to enact laws to regulate abortion after fetal viability but prohibits the government from restricting abortions to protect the life or physical or mental health of the pregnant person. In addition, the measure prohibits adverse action based on pregnancy outcomes and discrimination against individuals obtaining or assisting in reproductive health care. Missouri currently enforces a full abortion ban with an exception for medical emergencies.
Montana voters will have the opportunity to decide on reproductive rights with CI-128. The measure would amend the state constitution to provide a right to make decisions about one’s own pregnancy, including the right to abortion. In addition, it would prohibit the government from denying or burdening the right to abortion prior to fetal viability or when an abortion is medically indicated to protect a patient’s life or health. The measure would also prohibit the government from penalizing anyone who assists someone in exercising their right.
Abortion is currently legal in Montana, but there have been several attempts by lawmakers to enact abortion restrictions. However, such attempts have been overturned by the courts citing that the state’s constitutional right to privacy includes a right to abortion.
The ballot in Nebraska will include two abortion measures, Initiative 434 and Initiative 439. Initiative 434 amends the state constitution to prohibit abortions in the second and third trimesters, which is after 12 weeks, except in medical emergencies or when the pregnancy results from sexual assault or incest. Meanwhile, Initiative 439 amends the state constitution to establish a fundamental right to abortion until fetal viability or when needed to protect the life or health of a pregnant patient, without interference from the state or its political subdivisions. State officials have stated that if both measures pass, the measure with the most affirmative votes would be enacted. Abortion is currently illegal after 12 weeks in Nebraska under a law passed in 2023.
In Nevada, Question 6 is up for consideration by voters. The measure would create a constitutional right to an abortion, without interference by state or local governments, whenever the abortion is performed by a qualified healthcare professional until fetal viability or when necessary to protect the health or life of the pregnant individual at any point during the pregnancy.
Under the state constitution, citizen-initiated constitutional amendments are required to pass in two consecutive general elections. This is the first time this measure is appearing on the ballot, so if it passes it will have to be approved again in November 2026 to become law.
Abortion is currently legal in Nevada and explicitly permitted up to 24 weeks, which is typically considered fetal viability, under state law. This law was also affirmed by voters in 1990 via ballot measure and is not subject to legislative amendment or repeal.
In New York, Proposal 1 is on the ballot this year. As a legislatively referred constitutional amendment, the proposal had to pass the state legislature in two consecutive sessions. The legislature first passed the amendment in July 2022 and a second time in January 2023. Proposal 1 would expand the equal protection clause in the state constitution to include protections against unequal treatment based on ethnicity, national origin, age, disability, sex, sexual orientation, gender identity, gender expression, pregnancy, and pregnancy outcomes, as well as reproductive healthcare and autonomy.
New York legalized abortion up to 24 weeks, which is typically considered fetal viability, in 1970, and in 2019, New York enacted the Reproductive Health Act to allow abortions after 24 weeks if the health or life of the patient is at risk.
Citizens in South Dakota have the opportunity to vote on Amendment G to establish a constitutional right to abortion and a trimester framework to regulate abortion in the state. The measure would prohibit regulation of abortion during the first trimester, allow regulation of abortion in the second trimester that is reasonably related to the physical health of the pregnant woman, and allow regulation or prohibition of abortion in the third trimester, except in cases when the abortion is necessary to preserve the life or health of the pregnant woman.
All abortions are banned in South Dakota, with an exception to preserve the life of a pregnant woman under a trigger law passed in 2005 that went into effect after the Dobbs decision.
There's a lot to keep track of this year. Check out our 2024 State Elections Toolkit, with information on all key races, plus our popular State Elections Dashboard.
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