Voters in several states are heading to the ballot box Tuesday to select local or state representatives, as well as governors, and a handful of them also will be voting on measures that will affect healthcare policy.
The off-election year ballots include proposals that will affect Obamacare and drug prices, while other states have elections that could have a more indirect impact on healthcare policy.
Here are several healthcare-related issues being considered at the state level:
Medicaid expansion in Maine
Republican Gov. Paul LePage has vetoed Medicaid expansion under Obamacare five times, and on Tuesday the state is turning the issue to voters.
Obamacare was written to expand Medicaid to low-income people in all states instead of only specific groups of people, such as pregnant women or people with disabilities. The Supreme Court in 2012 made the provision optional for states. Nineteen states, including Maine, have not expanded the program.
LePage, who is not running for re-election next year because of term limits, has opposed expansion, because he said it would be too costly for the state. The federal government pays for the beginning of state expansion, but gradually shrinks its support to 90 percent after a few years.
An estimated 80,000 people in Maine are expected to become eligible for Medicaid if the ballot measure passes. Under the program, adults under the age of 65 who make less than $16,643 for an individual would qualify for government-funded healthcare.
Curbing drug prices in Ohio
Ohio voters will be asked to cast their ballot on the Drug Price Relief Act, which could become one of the most costly campaigns in the state's history. If the ballot initiative passes, it would require state agencies to pay no more than the Department of Veterans Affairs' rate for prescription drugs. The VA pays less for drugs than any government agency.
Sen. Bernie Sanders, I-Vt., has been a vocal proponent of the effort, as well as of other approaches that would allow the government to set drug prices. Other supporters say the state, through programs such as Medicaid and other health programs, would save $400 million a year.
Opponents, including the drug industry, say the bill could increase the cost of some drugs and cause certain medications to become unavailable. They argue as well that costs would be shifted onto Ohioans who have private health insurance coverage.
California failed to pass a similar measure during last year's election.
'Con con' in New York
New Yorkers are set to vote for or against a constitutional convention, which is a body of delegates that comes up with proposals to change or rewrite parts of the state constitution. Every 20 years, the electorate votes to answer the question: “Shall there be a convention to revise the constitution and amend the same?”
If the "con con" moves forward, proposals to New York's constitution that delegates approve are then brought before the public, who can reject or adopt them. The process wouldn't be kicked off until 2019, and voters rejected the last two conventions in 1997 and 1977.
Though New York's legislature also changes the constitution, it can only do so through passing an amendment twice, with an election in between, before a state referendum.
Opposition to the constitutional convention is a rare area of agreement for both abortion rights groups and groups that oppose abortion, who fear that the procedure would become either more or less restricted. Both the Planned Parenthood Empire State Act and New York Right to Life Committee are part of a large coalition of organizations that oppose a convention.
"There are a few certainties with a constitutional convention," Robin Chapelle Golston, chief executive of Planned Parenthood Empire State Act, wrote in a blog. "All our rights are vulnerable, and there are no guarantees when it comes electing delegates."
Groups that want a convention support issues related to the legalization of marijuana, term limits, and campaign finance.
Tax exemptions for Texas' disabled vets
Proposition 1 would authorize the Texas legislature to create property tax exemptions for partially disabled veterans or their surviving spouses. The exemption would mean their home isn't taxed at its full value because a certain amount becomes tax-free.
The legislature in May 2017 passed House Bill 150, which would authorize the exemption if voters approve the proposition. The bill would allow disabled veterans to claim a property tax break if they paid 50 percent or less of the market value for a house donated to them. The measure also would keep the existing tax exemption for partially disabled veterans who received their homes at no cost from a charity. Under current law, the tax break applies only if they did not pay anything for a donated home.
State house, governorship in Virginia
One of the most closely watched races Tuesday is not related to healthcare, but supporters of Obamacare say that if Democrats win the Virginia governor's mansion and the House of Delegates, the state likely would to try to expand Medicaid.
Polls show that the race between Republican Ed Gillespie and Lt. Gov. Ralph Northam, a Democrat, is close.
Virginia's incumbent, Democratic Gov. Terry McAuliffe, supports Medicaid expansion, but the Republican-majority legislature does not. If Virginia were to expand Medicaid, an estimated 400,000 residents could become eligible for the program.