Health care issues appear on California ballots next week directly and indirectly. Voters in several cities and counties will decide issues directly related to health care ranging from soda taxes to medical marijuana laws.
Although statewide propositions on next week's ballot don't deal specifically with health care issues, several could have profound effects on California's health care system at the local and state levels.
Proposition 30, Gov. Jerry Brown's (D) revenue-raising tax initiative, and Prop. 31, calling for changes in state and county government rules, probably have the most import for the state's health care system.
Two other measures -- Prop. 32, calling for changes in political contribution laws, and Prop. 37, which would require labeling of genetically modified food -- also have the potential to affect health care policy and financing down the road.
Health Care Effects of Statewide Measures
Although there is disagreement on what the health care ramifications of Props. 30 and 31 might be, there is general agreement that there will be some -- especially if Prop. 30 loses.
Prop. 30 would raise state income taxes on annual incomes higher than $250,000 and increase the state sales tax by 0.25%. Brown predicts most of the roughly $7 billion generated annually over the next seven years will go to public education and public safety programs.
If Prop. 30 fails, Brown said it will trigger more than $6 billion in immediate cuts to public education, from pre-school to the university system. It could mean teacher layoffs and increases in class sizes and college tuition.
Health care policy experts expect Prop. 30's failure also could trigger cuts in state health care programs that have been hit by budget reductions in each of the past four years.
Prop. 31 would establish two-year state budgets, create new rules for offsetting new expenditures and give the governor new power to make budget cuts in fiscal emergencies. The initiative would also give counties new authority to alter the way they deal with state statutes or regulations on state-funded programs.
Proponents say Prop. 31 will improve California's health care system. Some health care advocates worry that giving counties too much discretion could undermine state health care laws and programs.
Soda Taxes Top List of Local Health Measures
Voters in two California cities will decide if sugar-sweetened soda should be taxed for its contributions to poor public health.
Measure N in the East Bay city of Richmond would create a "business license fee" of one cent per ounce to be paid by retailers selling sugar-sweetened beverages.
In El Monte in Los Angeles County, voters will decide on Measure H, which also calls for a one-cent-per-ounce "sugary sweetened beverage license fee."
Jeff Ritterman -- city council member in Richmond and a leader of the campaign to tax soda -- said health experts endorse the tax plan.
"Thomas Frieden -- director of CDC, the country's head doc when it comes to prevention -- said that a one-cent-per-ounce sugar-sweetened beverage tax might be 'the single most effective measure to reverse the obesity epidemic,'" Ritterman wrote in a California Healthline Think Tank earlier this year.
"Fully one-third of Richmond's African-American and Latino fifth- and seventh-graders are obese. If we are not successful in discouraging behaviors that lead to weight gain -- like drinking soda -- most of these children and those that follow after them will have shorter lives than their parents," Ritterman wrote.
The proposals in Richmond and El Monte are opposed by soda industry interests and anti-tax groups.
California voters will consider other health-related issues in their communities, including compensation limits for hospital administrators, assisted living, increasing health care education opportunities, condoms in the adult film industry and medical marijuana.
In Santa Clara County, voters in the El Camino Hospital District will decide the fate of Measure M, which would limit annual compensation for hospital leaders to twice the annual salary paid California's governor, which is $173,987.
El Camino Hospital's top administrator reportedly has an annual salary of almost $700,000 plus a bonus. Measure M's passage would cut that by more than 50%.
In the city of Sierra Madre in Los Angeles County, voters will decide whether to amend city density rules to allow construction of an assisted living center.
In San Diego County, voters in the MiraCosta Community College District will vote on a proposal to issue bonds to pay for increased training for students aiming for careers in bio-technology, nursing and other health-related fields.
Los Angeles County voters will decide the fate of the Safer Sex Initiative, which calls for the use of condoms in adult films and would require the Los Angeles Department of Public Health to lead inspections and enforcement efforts.
Marijuana on Many Ballots
Sixteen years after California took the first legislative steps to recognize marijuana as medicine, cities and counties are still jockeying to regulate it. A half dozen medical marijuana measures appear on local ballots next week in California.
Voters in the City of Needles in San Bernardino County will decide whether city officials should have the ability to levy a new sales tax on marijuana dispensaries. State law already requires dispensaries to pay standard sales tax. The proposal in Needles would allow the city to impose a tax of up to 10% on a dispensary's sales revenues.
Regulation of medical marijuana dispensaries is on ballots in in four San Diego County cities -- Solana Beach, Lemon Grove, Imperial Beach and Del Mar.
Voters in the city of Palo Alto in Santa Clara County will decide the fate of a proposal to allow three medical marijuana dispensaries to open in any of the city's commercial or industrial zones.
Voters in other parts of the country will decide whether it's time to move beyond medical use of marijuana.
Ballot measures in Colorado, Oregon and Washington state would allow marijuana for a wide variety of uses -- including recreational. All three directly challenge the federal law prohibiting marijuana.