Numerous state ballot initiatives and referenda that will have significant consequences for children and families will appear before voters this fall, presenting AAP chapters and members with opportunities for advocacy.
More than 100 individual initiatives and referenda will be considered in the Nov. 5 election in the 26 states that permit them. The results will set state policy on myriad issues, including access to reproductive health care, marijuana legalization, taxation, fiscal policy and voting rights.
Abortion rights
Among the most hotly contested issues before voters is abortion rights.
According to the Kaiser Family Foundation, 15 states (Arizona, Arkansas, Colorado, Florida, Hawaii, Iowa, Maine, Maryland, Missouri, Montana, Nebraska, Nevada, Pennsylvania, South Dakota and Washington) are expected to have questions regarding abortion rights on the ballot or are in the process of collecting signatures for qualification on this year’s ballot.
Public opinion polling and results from prior elections show voters favor expanded access to abortion. Seven states have had ballot initiatives seeking to expand abortion access since the Dobbs v. Jackson Women’s Health Organization decision overturned Roe v. Wade, and all were approved.
AAP policy supports confidential and safe access to abortion for adolescent patients (https://bit.ly/3wQpMjS). More information is available at https://bit.ly/3yxT1s9.
Cannabis legalization
At least three states (Florida, Nebraska and South Dakota) will have ballot initiatives to legalize cannabis for recreational use, and three states (Arkansas, Idaho and Nebraska) are considering the creation or expansion of medical cannabis programs.
The recently proposed rescheduling of cannabis as a Schedule III drug by the Drug Enforcement Administration and the potential easing of federal restrictions on cannabis-related businesses could make this an economic issue as well as a health-related matter.
AAP policy supports decriminalization of cannabis but opposes commercial legalization. It also recommends that cannabis be regulated in states where it is legal, similar to alcohol and tobacco products, to prevent youth initiation (https://bit.ly/3CZM3KF).
Opportunities for chapters, members
Advocacy supporting or opposing ballot measures is considered lobbying — not electioneering — and is permissible for both 501(c)(3) and (c)(6) tax-exempt AAP chapters under IRS regulations for nonprofit organizations.
Hot-button issues before voters also provide opportunities for AAP members to write op-eds and letters to the editor on the child health implications of an issue, ensuring that the needs of children and adolescents are on voters’ minds as they head to the polls. AAP resources on working with the media are available at https://bit.ly/3yGOByZ.
The AAP also is leading a nonpartisan Get Out the Vote campaign to provide pediatricians with tools to share the importance of voting. Learn more at https://bit.ly/3R3pyN1.
Ballot measure basics
Twenty-six states and Washington, D.C., permit statewide ballot initiatives or referenda, also known as citizen-initiated ballot measures.
An initiative is a proposed new law or constitutional amendment that is placed on the ballot by petition after a predetermined number of qualified voter signatures are collected.
There are two types of initiatives: direct and indirect.
For direct initiatives, once a sufficient number of signatures has been collected, the proposal generally is placed on the ballot for an up or down vote by the people.
In the indirect initiative process, a proposed initiative is referred to the legislature after proponents have gathered the required number of signatures. The legislature has the option to enact, defeat or amend the measure. Depending on the legislature’s action, the proponents may continue to pursue placement on the ballot for a popular vote.
A referendum question is a measure that appears on the ballot as a result of a voter petition drive. It is used by voters to approve or repeal an act of the legislature.
Legislative referenda questions are referred by a state legislature to voters for their approval or disapproval. Advisory referenda allow legislatures, and, in some states, the governor, to place a question on the ballot to gauge voter opinion. The results of these ballot questions are not binding.
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