California bans flavored tobacco and other health measures on the ballot: What to know

Beyond the avalanche of state abortion measures and national worries about inflation and the future of democracy, voters decided critical ballot measures that charted the influence of states over health care.

Voters in five states weighed in on marijuana legalization, and others took on extending government health insurance for low-income families, flavored tobacco bans and medical debt collection limits.

Here's a rundown of key health measures from Maryland to California:

California cracks down on flavored tobacco products, vapes

Vaping foes counted another victory in California, where voters passed a ballot measure that banned flavored tobacco products. Proposition 31 bans the sale of flavored and menthol tobacco products at retail locations and vending machines.

A campaign funded by the tobacco industry had effectively blocked a flavored tobacco ban passed two years ago by the California legislature. The tobacco industry campaign gathered enough signatures to put the issue on this year's statewide ballot.

Anti-tobacco groups that have urged the federal government to ban flavored e-cigarettes applauded passage of the California measure. In a statement, the American Heart Association said voters sent a "major statement in support of our children's health and against the tobacco industry."

In October, the 2022 National Youth Tobacco Survey showed 14.1% of high school students and 3.3% of middle school students used nicotine-delivering vaping devices at least once over the past 30 days. Among teens who vaped, the survey found 85% said they used flavored e-cigarettes.

Arizona limits interest rate on medical debt

Voters in Arizona approved a ballot measure that caps the interest rate for medical debt at 3%. It also protects consumers from wage garnishment and increases the value of assets such as houses and cars that are protected from creditors.

Arizona's Proposition 209, the Predatory Debt Collection Act, applies the interest rate cap of 3% only to new medical debt. Existing debt would not be protected from higher interest rates.

Opponents included financial institutions and business interests that said the measure will weaken creditors' ability to collect debts. One possible outcome: Banks and lenders may be less willing to give out loans, harming working Arizonans, according to opponents.

South Dakota expands Medicaid coverage for low-income families

South Dakota voters approved the expansion of Medicaid health insurance to low-income residents through a constitutional amendment.

Voters approved Constitutional Amendment D, which extends the government health insurance program to people earning up to 138% of the federal poverty level—currently about $18,800 for an individual or $38,300 for a family of four. South Dakota had been one of 12 states that had not expanded Medicaid under President Barack Obama's signature 2010 health care law, the Affordable Care Act.

The Republican-controlled legislature and Gov. Kristi Noem have resisted Medicaid expansion. Proponents for expansion have found success through ballot measures across GOP-dominated states, and a wide coalition of health care groups and organizations backed a well-funded ballot campaign this year in South Dakota.

The measure requires South Dakota to implement coverage by July 1, and prohibits the state from imposing burdens or restrictions for those who are eligible, according to Kaiser Family Foundation.

Families U.S. executive director Frederick Isasi praised voters who approved the measure that would extend coverage to about 42,500 low-income individuals.

"South Dakota is healthier and more productive when everyone is covered," Isasi said in a statement. "Amendment D's passage is a signal to other states that ensuring Medicaid can help working-class families stay healthy and get care is a popular, important solution to save lives and protect families' pocketbooks."

Maryland, Missouri approve recreational marijuana

Voters in Maryland and Missouri approved legalizing recreational marijuana for people 21 and older as voters in Arkansas, North Dakota and South Dakota rejected legalization.

The Maryland and Missouri measures will change criminal law and expunge many past marijuana possession convictions. Missouri's measure expunges nonviolent marijuana offenses, except for selling to minors or driving under the influence.

Last month, President Joe Biden announced he was pardoning thousands with federal convictions for simple possession of marijuana. While most convictions occur at the state level, marijuana legalization advocates praised Biden's move to address federal convictions.

Oregon measure to declare health care as a right too close to call

Oregon's measure that would declare health care as a right trailed but was too close to call. Measure 111 would amend the state's constitution to ensure every resident has access to cost-effective and affordable health care. The measure does not spell out how the state would pay pay for expanded health care access. If voters pass the initiative, it would be up to the Legislature to determine how to make it work.

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