Election 2016: Know Your Ballot

This election cycle, the top of the ticket is in the spotlight, and for good reason. However, California voters will also be considering a sizeable list of ballot propositions.

Some of this year’s ballot measures address pressing public health issues like prescription drug prices, funding for healthcare programs, legalizing marijuana, tobacco taxes, and even the adult film industry.

To help inform the UCSF community, the Health Policy Interest Group hosted a Know Your Ballot event featuring lively discussion and nonpartisan presentations on selected state and city-level ballot measures.

The information included in this article and presented during the Know Your Ballot event was compiled by UCSF medical students Amy Pugh, Prihatha Narasimmaraj, Madeline Tiee, and Nicholas Murphy, along with UCSF pharmacy students Truc Dinh, Devin Erbay, and Hannah Whittemore.

If you’re on the fence about any propositions or simply want to learn more, read on.

Proposition 61: The California Drug Price Relief Act

Background: Existing federal law places upper limits on the list prices that the US Department of Veterans Affairs (VA) pays for prescription drugs. List prices for the VA are generally lower than those for private payers, and the VA obtains additional discounts through rebates.

Prop 61 would prohibit the California state Medicaid program (Medi-Cal) from paying more for any prescription drug than the VA pays, with some exceptions. More money has been spent on Prop 61 than any other 2016 California State ballot proposition.

Arguments in Opposition:

• Prop 61 could prompt drug manufacturers to raise prices for the VA.
• Manufacturers may react by removing their drugs from the Medi-Cal formulary, decreasing patient access to medications.
• Prop 61’s opponents include the California Pharmacists Association, California Medical Association, the SF Chronicle, and the pharmaceutical industry.

Arguments in Favor:

• Prop 61 would yield massive cost savings on state drug spending.
• Competition will still provide pressure for drug manufacturers to keep their drugs on the Medi-Cal formulary.
• Multiple pieces of more moderate drug price legislation have been defeated in the state legislature, leaving ballot initiatives like Prop 61 as perhaps the only option to address the issue.
• Prop 61’s supporters include the California Nurses Association, AARP, and Senator Bernie Sanders.

Prop 64: Legalizing Recreational Marijuana

Background: Voting yes on Prop 64 would allow adults aged 21 years or older to possess and use marijuana for recreational purposes. It would tax the cultivation and sale of marijuana, with tax revenue supporting drug research, enforcement, health and safety grants, and youth programs.

Arguments in Favor:

• Prop 64 would generate tax revenue, decrease law enforcement costs, and decrease black market or drug cartel activity
• Drug convictions disproportionally affect minorities and populations with lower socioeconomic status.
• Prop 64 incorporates best practices from other states that have legalized marijuana.
• Prop 64’s supporters include the California Democratic Party, ACLU of California, California Medical Association, California Nurses Association, and Senator Bernie Sanders, among others.

Arguments in Opposition:

• Currently, there is no technology to detect whether drivers are under the influence of marijuana.
• Prop 64 might increase marijuana access and use among teens, with adverse effects on brain development possible even after age 21.
• “Big Tobacco” could become “Big Weed.”
• Prop 64 does not ban marijuana advertising.
• Decriminalizing marijuana possession – a step short of legalizing its use – goes a long way in addressing the inequality in drug imprisonment rates.
• Prop 64’s opponents include the California Hospital Association, California Republican Party, several local city councils and law enforcement associations, and US Senator Dianne Feinstein.

Prop 56: Increasing the State Tobacco Tax

Background: Voting yes on Prop 56 would increase the state per-pack cigarette tax from $0.87 to $2.87, with an equivalent increase on other tobacco products and nicotine-containing e-cigarettes. The majority of the revenue would go to Medi-Cal, with the rest going to research, prevention, and treatment of tobacco-related disease.

Arguments in Favor:

• Evidence generally suggests that increasing the cost of tobacco products through taxes reduces their use.
• The tax would also apply to e-cigarettes, which are largely unregulated and possibly targeted towards younger consumers.
• California’s current 87-cent tax is low compared to most other states’ tobacco taxes.
• Tobacco use costs California an estimated $9 billion in healthcare expenses, $3.6 billion of which are paid by Medi-Cal. An increased tobacco tax would essentially be a user fee to help cover this cost to the healthcare system.
• Revenue from the tax could improve access to care by increasing Medi-Cal reimbursement rates for healthcare providers, allowing more providers to accept Medi-Cal patients.
• Prop 56’s supporters include the California Democratic Party, NAACP, American Heart Association, American Cancer Network, American Lung Association, American Academy of Pediatrics, California Dental Association, and United Nurses Association of California, among others.

Arguments in Opposition:

• A tobacco tax is regressive, as low-income individuals are more likely to smoke and spend a larger portion of their income on tobacco products.
• If the tax is successful in reducing tobacco use, revenue raised from the tax – and therefore funding for Medi-Cal – will decrease over time.
• Prop 56’s opponents include the California Republican Party, Taxpayers Association, Retailers Association, Black Chamber of Commerce, and the tobacco industry.

Prop 60: Condoms in Pornographic Films

Background: Prop 60 would require performers in adult films to use condoms during filming sexual intercourse, among other regulations of the adult film industry.

Arguments in Favor:

• STIs are a serious potential health threat to workers in the adult film industry.
• Condom use in adult films would set a positive example for consumers.
• Prop 60’s supporters are limited, and include the AIDS Healthcare Foundation.

Arguments in Opposition:

• Prop 60 could drive the adult film industry underground or out of the state, where there are fewer regulations and worker protections.
• This measure was written without consulting the industry.
• The specifics of the measure allow anyone to sue film producers, and legal proceedings could force adult film actors who work under stage names to reveal their real names.
• Prop 60’s opponents include the Democratic and Republican parties, the SF AIDS Foundation, the St. James Infirmary, and multiple newspapers.

Prop 52: Voter Approval to Divert Hospital Fee Revenue Dedicated to Medi-Cal

Background: Starting in 2009, California’s private hospitals agreed to a fee program that would increase the federal government’s matching share of Medi-Cal, the state’s Medicaid program. The legislature has renewed this fee program several times, but it is set to expire at the end of 2017.

Voting yes on this proposition would indefinitely extend this fee program and would prevent this money from being diverted for other purposes.

Arguments in favor:

• Prop 52 would generate more federal matching funds for Medi-Cal, which improves access and quality of care for 13 million Californians.
• It would prohibit the legislature from using these funds for any other purpose without the people’s vote.
• Supported by the state Republican and Democratic parties, the California Hospital Association, numerous private hospitals & health systems, and several unions, among others.

Arguments in opposition:

• Favors corporations and hospital CEO’s by reducing accountability about where funds go.
• Prop 52’s opponents include the group Californians for Hospital Accountability and Quality.

San Francisco City Measure Q: Prohibiting Tents on Public Sidewalks

Background: City law currently prohibits willful obstruction of public sidewalks, and prohibits lying or sitting on public sidewalks between 7 AM and 11 PM, but it does not prohibit placing tents on sidewalks. There is currently a shortage of shelter beds in the city. Measure Q would prohibit tents on sidewalks and allow removal with a 24-hour notice, with assurance of shelter for one night.

Arguments in favor:

• Tents on streets are not a safe or healthy place for individuals to live
• Tents obstruct public space.
• Measure Q’s supporters include donors from the tech industry, along with city Supervisors Farrell, Tang, Cohen, and Wiener.

Arguments in opposition:

• The city already has the authority to remove public health hazards or willful obstructions of sidewalks
• The shelter and housing system is overburdened as it is
• The measure may force people to sleep outside without tents
• Measure Q’s opponents include the Chair of the California Democratic Party, the Coalition on Homelessness, and city Supervisors Avalos, Mar, and Peskin.

For even more information on these and other ballot measures, we recommend the California State Official Voter Guide, Ballotpedia, and the KQED voter guide. Happy voting!