Voters settled healthcare questions in more than a dozen states Nov. 3, and the results will land squarely in hospital and health plan budgets for 2027.
Vote shares below are unofficial counts as of Nov. 4 unless noted; several races were still being tallied.
Medicaid and coverage
- South Dakota Amendment I: failed, 44.2% to 55.8%. The state Legislature-referred amendment would have removed the state’s constitutional Medicaid expansion requirement if the federal share of expansion costs fell below 90%. Voters added expansion to the constitution in 2022; it covers adults up to 138% of the federal poverty level, roughly 30,000 people. Supporters had argued each 10-point drop in the federal match would cost the state about $36 million a year, ABC affiliate KOTA reported Nov. 4.
Reproductive care
- Missouri Amendment 3: failed, 44.5% to 55.5%. The state Legislature-referred measure would have repealed the abortion-rights amendment voters passed in 2024 with 52% and banned gender-transition procedures for minors. Opposition grew from 2024 in all but 11 counties, NPR affiliate KCUR reported Nov. 6.
- Nevada Question 6: passed, about 63% to 37%. The amendment writes abortion rights into the state constitution; abortion was already legal through 24 weeks under a 1990s statute, NBC affiliate KSNV reported Nov. 5.
- Virginia Question 1: passed, about 62% to 38%. The amendment protects decisions on prenatal care, childbirth, contraception, abortion, miscarriage management and fertility care, effective Jan. 1, CBS affiliate WUSA reported Nov. 3.
- Idaho Proposition 1: failed, 44% to 56%. The statutory initiative would have created a right to reproductive care, including abortion before viability. The state’s near-total ban stays in place, NPR affiliate KUNR reported Nov. 4.
Health funding and taxes
- California Proposition 40: trailing, about 44% voting yes. SEIU-United Healthcare Workers West put a one-time 5% tax on billionaires’ net worth on the ballot, saying it would raise about $100 billion over five years for health programs hit by federal cuts, Cal Matters reported Nov. 3.
- California Proposition 44: failed, about 18% to 82%. Also backed by SEIU-United Healthcare Workers West, it would have required covered nonprofit community health centers to spend at least 90% of revenue on patient care, Cal Matters reported.
- California Proposition 38: leading, about 56% voting yes. The measure authorizes $8.4 billion in bonds for immunology research. About half would go to the California Institute for Immunology and Immunotherapy, co-founded by the measure’s sponsor, Gary Michelson, MD, Cal Matters reported.
- Colorado Amendment 87: approved, 51.4% voting yes. It creates a graduated income tax, with added revenue directed to healthcare and education; Proposition 136, a competing 4.4% tax cap, trailed, the Colorado Sun reported Nov. 6.
- Marin Healthcare District Measure CC (Calif.): leading, 56.6% voting yes. The 30-year parcel tax would raise an estimated $12.4 million a year for hospital facilities, emergency and critical care, and clinician staffing.
- Bonds: New Mexico Bond Question 1 passed with 69.6% of the vote, authorizing about $21.6 million for older adult facilities. Rhode Island Question 1 passed with 59.9%, including $165 million for Kingston-based University of Rhode Island’s Integrated Health Building, the Rhode Island Current reported Nov. 3.
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