With 17 statewide initiatives, the November 2016 ballot includes the largest number of measures since 2000, when 20 measures qualified. Among these initiatives are a handful that could have a significant impact on patient access to care and the state of health care in California.

Vote with California’s doctors to increase patient access to care and improve health care in the Golden State! Below is a summary of the propositions as they relate to health care, as well as the California Medical Association's official positions on the measures.

Proposition 52: State Fees on Hospitals. Federal Medi-Cal Matching Funds. Initiative Statutory and Constitutional Amendment
CMA Position: Support

Since 2009, California has partnered with hospitals to secure $2 billion per year in federal matching funds for Medi-Cal. This alliance ensures vital access to health care for nearly 7 million California children, providing essential health services such as medical check-ups, immunizations, important prescriptions, dental and vision care. Several years ago, California diverted some of the funds from the hospital fee program to the state's general fund. The initiative will add language to the Constitution to prevent diversion by requiring voter approval of changes to the hospital fee program.

Proposition 53: California Voter Approval Requirement for Revenue Bonds Above $2 Billion Initiative
CMA Position: Oppose

Prop. 53 would "require voter approval for projects larger than $2 billion that are financed through 'revenue bonds,'" a type of bond that is "repaid through tolls or fees paid by users" rather than from the state's general fund.  It takes away local control and creates an atmosphere of uncertainty around projects, which could result in higher costs and a loss of investment money in urban projects. Because of this uncertainty, it could impact medical care by curtailing the ability of state and local government to finance projects to build or rebuild major infrastructure. It also fails to contain an exemption for emergencies, in cases of an earthquake or flood, the state and local governments may need to wait as long as two years in order to get voter approval to begin rebuilding.

Proposition 55: California Extension of the Proposition 30 Income Tax Increase Initiative
CMA Position: Support

It extends the temporary personal income tax increases enacted in 2012 on earnings over $250,000 by 12 years, with revenues allocated to K-12 schools, California Community Colleges, and health care. The measure would increase state revenues—$4 billion to $9 billion annually from 2019-2030. It would also provide almost $2 billion in funds to improve access to health care for low-income children and their families.

Proposition 56: California Healthcare, Research and Prevention Tobacco Tax Act of 2016
CMA Position: Support

CMA is a proponent of this initiative that is supported by a broad alliance of physicians, health care advocates, educators and others – would raise California’s tobacco tax, which is currently among the lowest in the country, to $2.87 a pack. The majority of the money from the initiative’s user fee on cigarettes and other tobacco products, including e-cigarettes containing nicotine, will be used for existing health programs and research into cures for cancer and other illnesses caused by smoking and tobacco products.

Proposition 58: California Non-English Languages Allowed in Public Education Act
CMA Position: Support

The measure would repeal most of the 1998 Proposition 227, the "English in Public Schools" Initiative, thus effectively allowing non-English languages to be used in public educational instruction and bring back bilingual education. Research shows that bilingual education, when it is well-designed and implemented, can be at least as good, and often better at helping immigrant and other non-English speaking students gain academic proficiency. Forty percent of the California population is Latino, but only four percent of them are physicians. CMA supports this measure in the hopes bilingual education would encourage young people with language skills and cultural competency to chose health care as a vocation and improve care to Californians.

Proposition 61: Drug Price Standards Initiative
CMA Position: Oppose

The initiative would require state health programs to pay no more for prescription drugs than the discounted rate that the Veterans Association pays. The measure is a deceptive proposition that will increase drug prices, reduce access to medicines, while increasing red tape and taxpayer costs. The Legislative Analyst’s Office found that Medi-Cal fee-for-service, with 3 million people could be hit with higher, not lower, costs. Similarly, CalPERS, which provides retirement and health care benefits to California state government workers, raised red flags, citing, “decreased access to certain drugs for CalPERS members” and “increased administrative costs” under Prop. 61.

Proposition 63: “Safety for All”
CMA Position: Support

Prop. 63 would prohibit the possession of large-capacity ammunition magazines and require most individuals to pass a background check, as well as obtain authorization from the California Department of Justice to purchase ammunition. CMA’s Board of Trustees, which is composed of physicians elected by their peers, endorsed the measure during its July meeting. In 1994, CMA declared the high volume of guns in California a major public health problem, and the decision to endorse Prop. 63 builds on CMA’s long history of protecting public health and promoting healthy California communities.

Proposition 64: California Marijuana Legalization Initiative
CMA Position: Support

Proposition 64 would allow adults aged 21 years old or older to possess and use cannabis for recreational purposes. The measure would create two new taxes, one levied on cultivation and the other on retail price. Revenue from the taxes would be spent on drug research, treatment, and enforcement, health and safety grants addressing cannabis, youth programs, and preventing environmental damage resulting from illegal marijuana production. CMA has adopted official policy recommending legalization and regulation of cannabis. The decision was based on a CMA white paper that concludes physicians should have access to better research, which is not possible under current drug policy.