In a time when health disparities continue to widen, ballot measures have emerged as a beacon of hope, empowering voters to shape policies that directly affect their lives. However, this democratic tool is now under threat. At a recent Ethnic Media Services briefing titled Ballot Measures Are a Key Tool to Achieving Health Equity—But They’re Under Attack, experts and activists convened to discuss the critical role ballot initiatives play in advancing health equity—and the mounting efforts to restrict them.
The Power of Ballot Measures in Advancing Health Equity
Avenel Joseph, Interim Executive Vice President of the Robert Wood Johnson Foundation, opened the discussion with a compelling message: ballot measures are vital in addressing systemic health disparities. She outlined how these initiatives have enabled communities to advocate for policies on abortion rights, paid sick leave, minimum wage increases, and access to clean water. Joseph shared a striking statistic: between 2014 and 2023, more than 63% of successful ballot initiatives nationwide were health-related.
“Ballot measures give power directly to the people,” Joseph explained. “They are often the last line of defense when legislative bodies fail to act on behalf of communities in need.” She emphasized that safeguarding this tool is essential to transforming health care from a privilege into a right.
Growing Threats to Direct Democracy
Despite their success in driving social change, ballot measures are under siege. The speakers warned of an alarming rise in legislative efforts aimed at restricting access to this democratic process. Joseph noted that in 2023 alone, 75 bills were introduced to curtail ballot initiatives, and by 2024, that number had already surged to 103.
“These restrictions are not accidental,” she said. “They are strategic attacks designed to block progress on critical issues like paid leave, abortion access, and wage increases.”
The Human Impact of Ballot Initiatives
Richard Von Glahn, Political Director of Missouri Jobs with Justice, illustrated the transformative power of ballot measures by recounting victories in Missouri. His organization has used ballot initiatives to secure significant wins, including raising the minimum wage and expanding Medicaid.
Von Glahn shared stories of people like Terrence Wise, a long-time fast-food worker and activist, who has fought for the right not just to survive but to thrive. He also highlighted Fran Marion’s struggle as a single mother, forced to leave her sick child at home to keep her job. “These stories are not isolated,” Von Glahn said. “They reflect the harsh realities faced by low-wage workers across the country.”
Missouri’s minimum wage initiatives, approved by voters, have set the state on a path to reach $15 an hour by 2026. A ballot measure also ensured that over 250,000 Missourians gained access to health care through Medicaid expansion. “These victories are a testament to the power of grassroots activism,” he added, noting that hundreds of volunteers collected over 210,000 signatures and knocked on 150,000 doors to bring these measures to fruition.
The Fight to Protect Ballot Access
Chris Melody Fields Figueiredo, Executive Director of the Ballot Initiative Strategy Center Foundation, warned that the battle is far from over. She highlighted several tactics used to undermine ballot initiatives, including raising voting thresholds, imposing legal and financial barriers, and deploying misinformation campaigns.
“In Florida, for example, a supermajority requirement has made it nearly impossible to pass measures,” Figueiredo explained. “Even when 57% of voters supported an abortion access initiative, it failed to meet the 60% threshold.” She also pointed to efforts in other states to increase the complexity and cost of signature gathering, disproportionately affecting grassroots campaigns.
Figueiredo emphasized that these attacks are often accompanied by state-backed opposition, with governments using public funds and law enforcement to intimidate voters and suppress initiatives. “It’s a deliberate strategy to stifle progress,” she said.
Despite these challenges, Figueiredo remains hopeful. She highlighted recent victories in Arizona and North Dakota, where attempts to impose restrictive ballot measures were defeated. “The public’s support for direct democracy is strong,” she noted. “Our task is to keep them engaged and informed.”
Strategies for Defense and Expansion
The speakers outlined a multi-pronged strategy to protect and expand ballot access. Joseph detailed efforts by the Robert Wood Johnson Foundation and its partners to:
- Support advocacy organizations working to defend ballot measures.
- Raise public awareness about the connection between ballot initiatives and health equity.
- Expand access to ballot initiatives in more states.
- Engage philanthropists to invest in protecting direct democracy.
- Von Glahn and Figueiredo echoed the need for continuous voter education and grassroots mobilization. They stressed that protecting ballot measures is not just about preserving a tool—it’s about safeguarding democracy itself.
A Call to Action
“Ballot measures are a cornerstone of democracy,” Joseph declared. “They give people the power to shape their own futures.”
Von Glahn urged communities to stay vigilant and continue organizing. “The fight for health equity and workers’ rights is far from over,” he said. “But when we come together, we can achieve real change.”
Figueiredo added a final note of encouragement: “Direct democracy bridges partisan divides. It’s about giving everyone a voice, regardless of political affiliation.”
Despite the mounting challenges, the speakers agreed on one thing: ballot measures remain a powerful force for justice, offering hope for a more equitable future.
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