Voters in several states will weigh in on healthcare-related ballot measures Nov. 3, including proposals tied to Medicaid funding, clinic spending and abortion access.
Here are eight healthcare-related ballot measures to know:
Medicaid, funding and access
1. South Dakota, Amendment I: The constitutional amendment would end the state’s expanded Medicaid coverage if federal funding for the expansion drops below 90%, according to the attorney general’s explanation in the South Dakota secretary of state’s ballot question pamphlet. Coverage would then go back to the groups Medicaid covered before voters approved expansion in 2022. Federal law currently requires the federal government to pay 90% of the expansion’s cost. Supporters and opponents both say in the pamphlet that about 30,000 South Dakotans are covered through expansion.
2. California, Proposition 44: The measure would require private nonprofit safety-net clinics to spend at least 90% of their revenue each year on healthcare services, according to the Legislative Analyst’s Office analysis in the state’s official voter guide. Clinics report spending about 80% on average. Clinics that fall short would pay a penalty equal to the amount needed to reach 90%. They would get that money back if they comply within five years. The LAO said some clinics that cannot meet the minimum “might close instead.” State enforcement costs would be in the low tens of millions of dollars per year, paid for by fees on affected clinics.
3. California, Proposition 40: The measure would impose a one-time state tax equal to 5% of net worth on billionaires who lived in California on Jan. 1, 2026, according to the LAO analysis in the official voter guide. Ninety percent of the money would have to go to healthcare services, and the rest to education, food assistance and running the tax. The LAO estimates the state would probably collect tens of billions of dollars over several years. It also notes that state and federal governments spend more than $200 billion a year on state healthcare programs, mostly Medi-Cal.
4. Colorado, Proposition 135: The measure would bar healthcare professionals from performing gender-affirming surgery on patients younger than 18, according to the text of the measure posted by the Colorado General Assembly. State or federal funds, Medicaid reimbursement and insurance coverage could not be used for those surgeries. The measure makes exceptions for people born with a medically verifiable disorder of sex development, and it does not address hormone therapy. It would take effect Jan. 1, 2027.
Abortion and reproductive care
5. Missouri, Amendment 3: The constitutional amendment would repeal the reproductive healthcare rights voters approved in 2024, which include abortion through fetal viability, according to the Missouri secretary of state’s official ballot language. It would allow abortions in medical emergencies, for fetal anomalies, and for rape and incest under 12 weeks. It would also require parental or judicial consent for minors seeking abortions and ban gender-affirming care for minors, including surgery, hormone therapy and puberty blockers, with exceptions for specific medical conditions.
6. Nevada, Question 6: The measure would write Nevada’s current abortion law, which allows the procedure through 24 weeks of pregnancy, into the state constitution, The Nevada Independent reported July 31. Voters approved it in 2024 with 64.4% support. Constitutional amendments in Nevada must pass in two consecutive general elections.
7. Virginia, Question 1: The constitutional amendment would add a fundamental right to reproductive freedom to the state’s Bill of Rights, according to the Virginia Department of Elections’ explanation for voters. The right would cover prenatal care, childbirth, postpartum care, contraception, abortion, miscarriage management and fertility care. The state could regulate abortion in the third trimester but could not prohibit it when a physician judges it medically needed to protect the patient’s life or health, or when the fetus is not viable. The amendment would also protect patients and those who help them from being penalized.
8. Idaho, Proposition 1: The initiative would create a right to abortion before fetal viability, and after viability in medical emergencies, according to the Idaho secretary of state’s ballot information. It would also protect healthcare providers from professional discipline and from civil and criminal liability. Idaho currently bans abortion except to prevent the death of the pregnant woman, and in the first trimester in documented cases of rape or incest reported to law enforcement.
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