Palliative Care on the Ballot: A Roundup of Issues Related to Palliative and End-of-Life Care on Statewide Ballots, November 8, 2016
In all the contention leading to the November 8th election, the topic of healthcare has not been much discussed and palliative care not at all. In several states, however, important issues relevant to palliative and end-of-life care are up for consideration. Medical marijuana is big this year, on the ballot in four states (and recreational marijuana in five). Physician-assisted death is on the ballot in Colorado, having failed to pass the state’s legislature in 2015 and 2016. Colorado also has a single-payer state-run health payment system on the ballot, and other states are raising taxes on tobacco, removing them from medical equipment, and floating bonds to fund research. And North Dakota is giving "Compassionate Care" a whole new meaning!! Here’s a roundup; links will take you to specific language and pro/con discussions:
Issue 6, Arkansas Medical Marijuana Amendment of 2016, and Issue 7, Arkansas Medical Cannabis Statute: to legalize medical marijuana. The two measures differ in details and in implementation: Issue 6 as a state constitutional amendment and Issue 7 as an initiated state statute. If both pass, the one with the larger number of votes will take effect. Issue 6 charges the state Department of Health to define patient eligibility and health conditions that qualify for medical marijuana use. Issue 7 details specific conditions and symptoms, including intractable pain.
Proposition 56, Tobacco Tax Increase: increases tax on tobacco and tobacco products, including electronic cigarettes, to fund various initiatives including primary care and emergency physician training; cancer, cardiovascular and lung disease research; and to continue funding for other tobacco tax-supported programs.
Amendment 69, State Healthcare System: Authorizes a state tax increase, assessed from payroll and income taxes, totaling $25 billion to establish a state-administered healthcare payment system (ColoradoCare) to fund, as primary or secondary payment source, a defined set of healthcare services for all Colorado state residents. Services include “palliative and end-of-life care.” Relationships between ColoradoCare and other payers including Medicare and Medicaid are detailed in the full text of the amendment.
Proposition 106, Colorado End of Life Options Act: Creates statute establishing a legal framework under which competent, terminally ill patients with a prognosis of 6 months or less may request and receive a prescription for lethal medications for the purpose of ending their lives. Process steps are similar, though not identical, to similar statutes in Oregon and California.
Amendment 2, Medical Marijuana Legalization: a state constitutional amendment to allow physicians to prescribe marijuana to eligible patients with specific conditions, including cancer, ALS, HIV/AIDS, Parkinson’s, and others.
I-181, Bonds to Fund Biomedical Research Authority: establishes a state authority to oversee and review grant applications to promote development of therapies and cures for brain diseases and injuries and mental illnesses, including Alzheimer’s, Parkinson’s, brain cancer, dementia, traumatic brain injury and stroke by Montana biomedical research organizations.
I-182, Medical Marijuana Initiative: amends an initiative approved by voters in 2004, which had been hobbled by a repeal attempt and veto of the repeal. Allows prescription of marijuana to patients with debilitating medical conditions, including cancer, HIV/AIDS, and others, that produce wasting, chronic pain, nausea, seizures, or other conditions defined by the state. This measure includes PTSD in the qualifying conditions.
Question 4, Medical Equipment Sales Tax Exemption Initiative (a.k.a. Medical Patient Tax Relief Act): state constitutional amendment to exempt from sales and use tax durable medical equipment, oxygen delivery equipment, and mobility-enhancing equipment prescribed by licensed health care provider.
Measure 5, Medical Marijuana Legalization Initiative (a.k.a. North Dakota Compassionate Care Act): creates state statute to legalize use of marijuana by eligible patients with debilitating medical conditions, including cancer, AIDS, hepatitis C, ALS, and others.