The Bounded Triumph of Health Care Ballot Initiatives
Back view portrait of young African-American people standing in voting booth and thinkingBack view portrait of young African-American people standing in voting... + "Medicaid expansion ballot initiatives show state referenda can expand health care access—but they have their limits," write Prof. Allison K. Hoffman and Katie Cohen L'24, MBE'24. At The Regulatory Review, health care law and policy expert Allison K. Hoffman, Professor of Law and Deputy Dean, and Katie Cohen L'24, MBE'24 explore how ballot initiatives offer progress for health care access but also caution that without federal action, their effects are limited as "those rights will only reach some people." From The Regulatory Review: Allison K. Hoffman, Professor of Law; Deputy Dean State ballot initiatives protecting reproductive rights across the country signal the public's rejection of the U.S. Supreme Court's decision overturning constitutional protection for abortions in Dobbs v. Jackson Women's Health Organization. Although some political experts are celebrating these ballot initiatives as a reproductive rights triumph, and rightly so, they should also be understood as qualified wins. These state efforts, and those that preceded them in recent years, aim to increase access to health care—they also shine a light on larger political process failures and the limits of correcting them. To address these failures, ballot initiatives must be fought and passed state by state. When reproductive and other health care access is left to referendum, it inevitably leaves gaps that are unevenly felt. The trajectory of state-level initiatives seen since Dobbs is not a new phenomenon in health care. Over the past six years, numerous Medicaid expansion ballot initiatives have corrected for coverage gaps created in the wake of the Supreme Court's 2012 Katie Cohen L'24, MBE'24 decision in NFIB v. Sebelius. This decision left expansion of health care to low-income populations in the hands of elected state representatives, many of whom have failed to act. Voters in seven states—Idaho, Maine, Missouri, Nebraska, Oklahoma, Utah, and South Dakota—rejected their legislators' inaction at the polls by petitioning for state referenda. The Fairness Project, a nonprofit dedicated to using ballot measures to circumvent deadlocks in legal change, spearheaded the movement to expand Medicaid through state ballot initiatives. Working with local partners, the organization helped Maine become the first state in the country to approve Medicaid expansion through a ballot initiative in 2017. The Fairness Project subsequently led successful referendum campaigns in Idaho, Nebraska, Utah, Oklahoma, Missouri, and South Dakota. American health system historian Paul Starr has commented that "the history of health insurance protection until the Supreme Court's decision on the Affordable Care Act in 2012 was almost entirely a history of legislative and administrative decisions." But recently, ballot initiatives have become the almost exclusive path to Medicaid expansion… . The Regulatory Review is a daily online publication that provides accessible coverage of regulatory policymaking and enforcement issues across a full range of regulatory topics and from a variety of perspectives. Launched in 2009 and operating under the guidance of Cary Coglianese, Edward B. Shils Professor of Law and Professor of Political Science, The Review is edited by students at Penn Carey Law. It is part of the overarching teaching, research, and outreach mission of the Penn Program on Regulation (PPR), which draws together more than 60 faculty from across the University of Pennsylvania. Read the full piece at The Regulatory Review.
Back view portrait of young African-American people standing in voting booth and thinkingBack view portrait of young African-American people standing in voting... + "Medicaid expansion ballot initiatives show state referenda can expand health care access—but they have their limits," write Prof. Allison K. Hoffman and Katie Cohen L'24, MBE'24. At The Regulatory Review, health care law and policy expert Allison K. Hoffman, Professor of Law and Deputy Dean, and Katie Cohen L'24, MBE'24 explore how ballot initiatives offer progress for health care access but also caution that without federal action, their effects are limited as "those rights will only reach some people." From The Regulatory Review: 
Allison K. Hoffman, Professor of Law; Deputy Dean State ballot initiatives protecting reproductive rights across the country signal the public's rejection of the U.S. Supreme Court's decision overturning constitutional protection for abortions in Dobbs v. Jackson Women's Health Organization. Although some political experts are celebrating these ballot initiatives as a reproductive rights triumph, and rightly so, they should also be understood as qualified wins. These state efforts, and those that preceded them in recent years, aim to increase access to health care—they also shine a light on larger political process failures and the limits of correcting them. To address these failures, ballot initiatives must be fought and passed state by state. When reproductive and other health care access is left to referendum, it inevitably leaves gaps that are unevenly felt. The trajectory of state-level initiatives seen since Dobbs is not a new phenomenon in health care. Over the past six years, numerous Medicaid expansion ballot initiatives have corrected for coverage gaps created in the wake of the Supreme Court's 2012 
Katie Cohen L'24, MBE'24 decision in NFIB v. Sebelius. This decision left expansion of health care to low-income populations in the hands of elected state representatives, many of whom have failed to act. Voters in seven states—Idaho, Maine, Missouri, Nebraska, Oklahoma, Utah, and South Dakota—rejected their legislators' inaction at the polls by petitioning for state referenda. The Fairness Project, a nonprofit dedicated to using ballot measures to circumvent deadlocks in legal change, spearheaded the movement to expand Medicaid through state ballot initiatives. Working with local partners, the organization helped Maine become the first state in the country to approve Medicaid expansion through a ballot initiative in 2017. The Fairness Project subsequently led successful referendum campaigns in Idaho, Nebraska, Utah, Oklahoma, Missouri, and South Dakota. American health system historian Paul Starr has commented that "the history of health insurance protection until the Supreme Court's decision on the Affordable Care Act in 2012 was almost entirely a history of legislative and administrative decisions." But recently, ballot initiatives have become the almost exclusive path to Medicaid expansion… . The Regulatory Review is a daily online publication that provides accessible coverage of regulatory policymaking and enforcement issues across a full range of regulatory topics and from a variety of perspectives. Launched in 2009 and operating under the guidance of Cary Coglianese, Edward B. Shils Professor of Law and Professor of Political Science, The Review is edited by students at Penn Carey Law. It is part of the overarching teaching, research, and outreach mission of the Penn Program on Regulation (PPR), which draws together more than 60 faculty from across the University of Pennsylvania. Read the full piece at The Regulatory Review.
