Physician Voter Guide: California Medical Association’s Ballot Measure Positions

October 28, 2016
Area(s) of Interest: Access to Care Advocacy 

By Ruth Haskins, M.D., President of the California Medical Association

#Election2016 is proving to be one of the most memorable election cycles in recent history — and we’re not just referring to the Clinton vs. Trump showdown for President of the United States.

Voters across California are opening their mailboxes to discover a behemoth voter guide that covers 17 statewide ballot propositions. Coming in at a whopping 224 pages, the 2016 voter guide is the largest in California’s history.

The California Medical Association represents over 43,000 physicians across all modes of practice. Our Board of Trustees approved positions on eight of the 17 measures. With your support, we can improve patients’ access to care and the state of health care in California.

Many of our positions support Medi-Cal, which now provides health insurance to one out of every three Californians. These measures will help the state continue to provide health care to roughly 12 million low-income families, seniors, children and the disabled.


Prop. 52: California Medi-Cal Hospital Reimbursement Initiative (CMA SUPPORTS)

In 2009, the state legislature passed bipartisan legislation enabling California to receive up to $3 billion a year in federal matching funds to provide health care for Medi-Cal patients. Since the bill’s passage, nearly $18 billion in federal matching funds have helped California children, seniors and working families — at no cost to taxpayers. This law is set to expire in 2018.

Prop. 52 would allow the state to continue drawing down federal health care funds. The Legislative Analyst’s Office (LAO) estimates this would provide over $1.5 billion in costs for health coverage by 2019–20. It also prevents the state legislature from diverting the fees to other state programs without voter approval.

Voting YES on Prop. 52 provides Medi-Cal patients with essential health services like check-ups, immunizations, prescriptions, dental and vision care. (YesProp52.org) (Facebook) (Twitter)

“Proposition 52 is a rare initiative for which there should be little debate or dissent… It doesn’t generate fierce debate. But Proposition 52 does make fiscal sense, and it is worthy of voters’ support.” — Sacramento Bee editorial

Prop. 53: California Public Vote on Bonds Initiative (CMA OPPOSES)

California’s infrastructure is largely outdated and in need of repairs and modernization to maintain safety, economic growth and quality of life. Prop. 53 would require voter approval before the state could issue more than $2 billion in public infrastructure bonds for state-managed projects.

This initiative could negatively impact medical care by curtailing the ability of the state of California and local government entities to build or rebuild major infrastructure projects. It also erodes local control, and there are no exemptions for emergencies or natural disasters.

Voting NO on Prop. 53 ensures critical infrastructure projects — including hospitals and medical facilities — aren’t subject to delays or loss of local control. (NoOnProp53.com) (Facebook) (Twitter)

“The problem that Proposition 53 aims to solve is speculative, but the potential damage to local control is real. Requiring state voters to approve large revenue bond issues would make it more difficult to make badly needed infrastructure improvements in this state, and could even discourage the public-private partnerships that could help fill the gap between what the state needs to build and what it can afford.” — Los Angeles Times editorial

Prop. 55: California Children’s Education and Health Care Protection Act of 2016 (CMA SUPPORTS)

Prop. 55 would extend current income tax rates for the wealthiest 2 percent of Californians — individuals earning more than $250,000 and couples earning more than $500,000 a year — for 12 more years.

The measure would enable local school districts to hire teachers and reduce class sizes, as well as provide state programs like Medi-Cal the needed funding to improve access to health care services. Budget forecasts show that unless we extend these taxes on the wealthy, our public schools will lose nearly $4 billion and our state budget will face a deficit of more than $4 billion in the first full year alone.

Voting YES on Prop. 55 would provide up to $2 billion annually to improve access to health care for low-income children and their families. 

“This is no solution to California’s overall tax system, which needs radical reform. It is a Band-aid. But the money is aimed at essential services — primarily education, with a small portion for healthcare. Given that the state’s economy has soared over the past four years and wealth has continued to flow mainly to the already wealthy, it’s hard to argue the tax increase has been onerous.” — San Jose Mercury News editorial

Prop. 56: California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (CMA SUPPORTS)

Smoking kills 40,000 Californians a year, making it the state’s #1 cause of preventable death, and taxpayers spend $3 billion a year on tobacco-related medical care. Prop. 56 would raise California’s tobacco tax, which is currently among the lowest in the country, to $2.87 a pack.

Designed as a user fee on cigarettes and other tobacco products, the majority of the money would be used for existing health programs and research into cures for cancer and other illnesses caused by smoking and tobacco products. Prop. 56 would triple funding for California’s anti-smoking programs, and the LAO said it would also raise $20 million a year for public schools to enhance smoking cessation programs.

Big Tobacco is predictably spending big money — $70 million so far — on deceptive and misleading advertisements. Their virtually unlimited funds have made the race tighten in recent weeks, but Prop. 56 still maintains a majority of voter support.

Voting YES on Prop. 56 would help save lives and prevent nearly 17,000 children a year from getting hooked on smoking. (YesOn56.org

“Nobody blows smoke in the face of voters better than the tobacco industry… Increasing tobacco taxes has proven again and again to be the most effective way to reduce smoking. This is why so many states have been far more progressive than California on this. Don’t let the tobacco industry that kills so many Americans kill Prop. 56. Think for yourself. Vote yes on this life-saving measure.” — San Jose Mercury News editorial

Prop. 58: The Language Education Acquisition and Readiness Now (LEARN) Initiative (CMA SUPPORTS)

Forty-four percent of California residents over the age of 5 speak a language other than English at home. Prop. 58 would allow school districts the option of providing bilingual education. It requires that schools offer a structured English immersion program for California’s 1.4 million English learners — one in five students — and those districts must seek input from educators, parents and the community.

Numerous studies support the need for multilingual health care providers. California needs a well-prepared and educated health care workforce that reflects our diverse society. Forty percent of Californians are Latino, but only 4 percent of the state’s doctors are Latino. By making bilingual education more accessible, we can increase the availability and the diversity of our physician community.

Voting YES on Prop. 58 would break down barriers by removing outdated mandates, helping physicians provide the best patient care for all Californians. (SupportProp58.com

“Parents would be more empowered under the initiative to have a voice in their children’s education than they were under the old system, and they’re unlikely to settle for programs that aren’t teaching their children English skills. The new accountability system for schools that the state is rolling out demands improvement in English fluency for non-native speakers. And if students aren’t achieving academically, Proposition 58 could be amended through a simple majority vote of the Legislature.” — Los Angeles Times editorial

Prop. 61: Drug Price Standards Initiative (CMA OPPOSES)

Increasing drug prices are negatively impacting patient access to care, but Prop. 61 imposes unworkable contracting requirements for some state prescription drug purchases based on prices paid by the U.S. Department of Veterans Affairs.

Prop. 61 symbolizes the “devil is in the details” cliché. While CMA is greatly concerned about increasing drug prices, this ballot measure is deeply flawed and untenable. Independent experts warn that the measure could increase state prescription drug costs while reducing patient access to medicines. The measure could also result in the invalidation of existing agreements between the state and pharmaceutical companies that already provide significant discounts to the state.

Voting NO on Prop. 61 would protect patients against a junk ballot measure. (NoOnProp61.com

“The underlying problem of fast-rising drug prices needs to be addressed comprehensively and nationally, so that relief for some doesn’t come at the expense of others… That’s hard work, and Proposition 61 doesn’t even pretend to do any of it. Voters should reject the measure and demand something better — not for drugmakers’ sake, but for their own.” — Los Angeles Times editorial

Prop. 63: Safety for All Act of 2016 (CMA SUPPORTS)

More than 300 Americans are shot each day, and firearms kill over 32,000 Americans each year. In 2013, over 6,000 Californians were hospitalized or treated in emergency rooms for non­fatal gunshot wounds, including 1,275 children and teens.

Prop. 63 would prohibit possession of large-capacity magazines, ensure criminals actually relinquish their firearms after conviction, require the reporting of lost or stolen firearms, strengthen background checks and regulate ammunition sales. It would also require gun dealer employees to pass annual background checks, help combat gun trafficking rings, ensure firearm theft is punishable as a felony, and require gun dealers to notify law enforcement when firearms and ammunition are lost or stolen.

Physicians understand all too well how gun violence can wreak havoc on our patients and communities. That’s why CMA declared the high volume of guns in California a major public heath issue in 1994.

Voting YES on Prop. 63 will help keep our communities safe and healthy places to live. 

“People using guns are responsible for the vast majority of homicides and suicides in California. Gun owners rail at Proposition 63, but it is a sensible step toward controlling the carnage. Vote yes.” — San Jose Mercury News editorial

Prop. 64: Adult Use of Marijuana Act (CMA SUPPORTS)

Twenty years ago, California voters approved Prop. 215, which legalized the medical use of cannabis. Prop. 64 would regulate and control the cultivation and use of non-medical cannabis, and the LAO estimates the measure would generate up to $1 billion in tax revenue for state and local governments.

Prop. 64 provides the highest level of annual funding (by any state) for youth drug prevention, education and treatment program. It also includes strict anti-monopoly safeguards, as well as warning labels and marketing bans for children.

As a matter of long-standing policy, CMA discourages smoking of any kind and believes that the most effective way to protect public health is to tightly control, track and regulate cannabis, as well as to comprehensively research and educate the public on its health impacts. We also issued a white paper in 2011 urging legalization and regulation of cannabis to allow for greater clinical research, oversight, accountability and quality control.

Voting YES on Prop. 64 would provide the oversight needed to protect public health and clarify the role of physicians in controlling and regulating the adult use of cannabis. (YesOn64.org

“Prop. 64 is the first step toward a rational drug policy. Prop. 64 gives California the opportunity to not only regulate the marijuana industry, but to make adjustments and clarifications when necessary. Though marijuana is currently illegal under federal law, the federal government has taken a hands-off approach to states choosing to responsibly regulate marijuana. This initiative allows California to do just that. It is time for a new approach. Vote yes on Prop. 64.” — Orange County Register editorial.

BONUS: Soda Tax Measures in the Bay Area (Measure V, HH and 01)

CMA has also endorsed three Bay Area ballot propositions aimed at reducing sugar intake to prevent diabetes and obesity:

  • Measure V in San Francisco (Tax on Distributing Sugar-Sweetened Beverages) proposes a 1-cent per ounce tax that is estimated to generate $14.4 million per year.
  • Measure HH in Oakland (Sugar-Sweetened Beverage Tax) proposes a 1-cent per ounce tax that is estimated to generate $6–8 million per year.
  • Measure 01 in Albany (Sugar-Sweetened Beverage General Tax) proposes a 1-cent per ounce tax that is estimated to generate at least $223,000 per year.

Sugary drinks are the biggest contributor (43 percent) of added calories in the American diet, and drinking just one soda a day increases a child’s likelihood of being overweight by 55 percent and an adult’s by 27 percent. Up to two sodas a day increase the risk of diabetes by 26 percent. The city of Berkeley passed the nation’s first soda tax in 2014, and the consumption of sugar-sweetened beverages has decreased by 21 percent since its implementation.

The science and firsthand experiences of doctors are clear: diabetes and obesity limit our patients’ full potential and quality of life. These diseases also cost California billions of dollars each year in lost productivity and health care costs, putting further strain on our public health system.

Voting YES on Measures V, HH and 01 would help break the cycle and negative impact of diabetes and obesity in our communities.

Dr. Haskins is an OB-GYN practicing out of Folsom, Calif. and has been a CMA and Sierra Sacramento Valley Medical Society member for 23 years. She served on the CMA Board of Trustees from 2013–15 and as chair of the CMA Council on Legislation from 2010–13.


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