Although our AASM election news coverage has been focusing recently on health care in the presidential race, there are several state health care measures being voted on in November that may affect your practice.

Prescription Drug Prices

In California, voters will be casting ballots on Proposition 61, the Drug Price Standards Initiative, which would prevent drug companies from charging state health care programs more than the negotiated price paid by the Department of Veterans Affairs (VA). Supporters of Proposition 61 state that it would cut the cost of prescription drugs, which means reimbursement rates for sleep aids could be affected. In fact, a 2005 Congressional Budget Office Report determined the VA paid approximately 42% of market prices across the nation, and, for those in the California Medicaid system, the VA pays about 51% of California market prices.

Opponents believe the potential savings are a mirage. In fact, opposition groups believe Proposition 61 would encourage pharmaceutical companies to increase the price they charge the VA, thereby creating a financial burden on the nation’s veterans. In addition, opponents are concerned the Proposition will be difficult to implement in the state and will ultimately cost taxpayers millions of dollars in lawsuits.

Currently, the Proposition 61 ballot measure is lining up to be one of the most expensive ballot initiatives in the country in 2016 with more than $79 million contributed from interested parties. Although the measure is opposed by the California Medical Association, Biotechnology Industry Organization, pharmaceutical industry, and several veterans’ groups, a recent poll of Californians showed that the measure is supported by approximately two-thirds of state voters.

Single-Payer Health Care System

In Colorado, residents will vote on whether to convert the state’s health care system to a single-payer model. Amendment 69 would create ColoradoCare, a government-financed payer that would eliminate the state’s Affordable Care Act (ACA) exchanges and replace most private insurance. Sleep physicians in Colorado would be the first to work under a single payer system.

Under the new system, deductibles and copayments would be eliminated for certain primary care and preventive services, and patients would be able to choose their doctors. A 21-member board would oversee the system, which would be financed through a combination of new state income taxes (an additional 10 percent income tax, with two-thirds paid by employers and one-third by employees) and redirected federal funding that currently goes toward ACA insurance subsidies and Medicaid. If the initiative is successful, Colorado could become the first state to opt out of the ACA by implementing its own universal health care coverage.

Supporters of Amendment 69 say it would cut health care costs by eliminating insurance company profits and reducing overhead expenses. However, the language of Amendment 69 would require every health care provider within the state to enter into a contract with ColoradoCare, which promises to reimburse providers at a rate “competitive with other states” when there are no comparable states at the present time. Thus, the reimbursement rate may be initially tied to the state Medicaid rate, which could lead more providers and hospitals out of business. Recently, the Colorado Hospital Association released an opposition paper arguing that the state-run system would reimburse providers less than private insurers and that its members already lose money caring for Medicaid beneficiaries due to low reimbursement rates.

Marijuana Legalization

The marijuana legalization issue also could be on your state ballot this November. Even though marijuana has gained state approvals for medicinal use in 24 states, and four states have legalized its recreational use, there could be up to 12 separate approvals in November. At the present time, four states (Arkansas, Florida, North Dakota and Oklahoma) have measures on the November ballot that will legalize medical marijuana in their state. Arkansas actually has 2 competing medical marijuana initiatives on the November ballot: The Arkansas Medical Marijuana Act (restricts access to state-approved dispensaries) and the Medical Cannabis Act (patients who have received the necessary approval from physicians and the state can grow marijuana plants on their own). Under both initiatives, there will be a procedure for sleep disorders to be afforded state approval for medical marijuana prescriptions. Should both initiatives win approval, the one with the highest number of “yes” votes will supersede the other.

In Florida, medical marijuana proponents have placed an amendment to the state’s Medical Marijuana program on the November 8 ballot. Three states are looking for approval to allow marijuana access for debilitating diseases (Florida, North Dakota) or for licensed use, sale and growth of marijuana for medicinal purposes (Oklahoma). Seven states (Arizona, California, Maine, Massachusetts, Michigan, Montana, and Nevada) are looking to secure a recreational marijuana initiative on the ballot.

The AASM will keep members updated on the outcome of these proposals. If these propositions pass, other states could soon see these proposals on other state ballots.