With President Obama’s reelection and Democrats retaining their control of the U.S. Senate, the Affordable Care Act appears to be on firm footing.
But Americans are still very much divided over the law. In a Kaiser Family Foundation poll taken a week before the general election, 38% of likely voters favored the Affordable Care Act (ACA), and 43% opposed it, with the remainder undecided. That division was evident on Election Day when voters in three states – Alabama, Montana, and Wyoming – voted to nullify the federal insurance mandate in the health law. A similar measure was on the ballot in Florida, but was rejected by voters.
While the language differed slightly, voters in Alabama, Montana, and Wyoming approved ballot measures amending their state constitutions to effectively bar the government from requiring individuals or employers to obtain or provide health insurance coverage.
This is not a new trend. In 2010, voters in Arizona, Missouri, and Oklahoma approved ballot measures rejecting the ACA’s individual insurance mandate. And in 2011, Ohio joined that list.
But the ballot measures are only symbolic victories for opponents of the 2010 health law. States don’t have the legal authority to supercede federal law. The only way to invalidate the individual insurance mandate would be through the passage of federal legislation or a court challenge. And the U.S. Supreme Court upheld the constitutionality of the insurance mandate earlier this year.
Another element of the ACA – health insurance exchanges – was also on the general election ballot. Voters in Missouri approved Proposition E, which amends the state’s constitution to bar the creation of a health insurance exchange except through legislation, a ballot initiative, or a veto referendum. The measure, which was approved by more than 60% of voters in the state, seeks to block the governor from setting up an exchange. That measure too is also largely symbolic since under the ACA the federal government is required to create and operate an exchange if a state fails to do so on its own.
Other issues were addressed via ballot initiative in the recent election. In Massachusetts, voters made it legal to use marijuana for medical reasons, but narrowly rejected a proposal that would have legalized physician-assisted suicide for certain terminally ill patients.
Abortion was another hot topic this year. Florida voters rejected a proposed constitutional amendment that would have barred the use of public funds to pay for abortions or for health insurance that included coverage of abortion.
In Montana, voters approved a parental notification measure for minors seeking abortions. Under the ballot measure, physicians would be barred from performing an abortion on a girl under age 16 unless they notify a parent or legal guardian at least 48 hours prior to the procedure. Notice is not required in medical emergencies or when waived by a court.