While the nation’s eyes were on candidates across the country during the 2018 Midterm Elections, policy was also in the making. Over 155 ballot initiatives were left up to voters in 37 states to decide. Issues ranged from abortion to health care and everything in between, allowing citizens to have a direct hand in the policy-making process rather than leaving it up to their elected officials. Here are a few of the most notable ballot measures that passed and their implications.

Abortion

Alabama and West Virginia, to the chagrin of pro-choice activists, passed strong anti-abortion measures on election night. In West Virginia, the newly adopted initiative will prevent taxpayer dollars from paying for abortions for those on Medicaid. The law effectively makes it harder for poor women to receive an abortion as they are the ones more likely to be using public insurance or Medicaid, putting another barrier between women and open access to abortion in the US. The contentious measure was narrowly passed with 51.67% of voters in the affirmative and 48.33% in the negative. In Alabama, the decision to put limits on abortion was a landslide victory for pro-life groups with nearly 60% of voters supporting a measure to codify protections for unborn life in the state constitution. Following the initiative’s adoption, it is understood that there are no explicit protections for abortion or abortion funding in Alabama’s constitution.

Both the West Virginia and Alabama measures fall in line with a new strategy used by anti-abortion groups to focus their efforts on state laws. Anticipating legal challenges that may reach the Supreme Court, pro-life activists have passed restrictive state level measures, rather than tackling Roe v. Wade, which is fairly stable on the federal level. A challenge to Alabama’s constitution will only get as far as the Alabama Supreme Court, but the message is clear: the legal trend in Alabama going forward, and presumably in other conservative Southern states, will be to codify anti-abortion measures rather than relying on the federal government to do so.

Marijuana

Michigan approved the use of recreational marijuana for those 21 and over and Utah and Missouri will now permit marijuana for medical purposes, joining 33 other states and the District of Columbia which have all legalized marijuana to varying degrees. As with legalization in other states, the more accepted cannabis use is the fewer people will be arrested for drug-related crimes, decreasing the amount of non-violent offenders in prison. Despite the fact that marijuana legalization is the general trend at the state level, the federal government still classifies it as a “Schedule 1 Drug,” ranking marijuana with other substances like heroin and LSD, drugs that have “no currently accepted medical use and a high potential for abuse.” Unfortunately, people already in prison for marijuana-related offenses need to serve out the rest of their sentences, but it isn’t far-fetched that these states will see an increase in appeals.

Criminal Justice

Perhaps the most interesting down-the-line effects will come from Colorado’s Amendment A, which bans slavery as a form of punishment. The technicality in their state constitution which allows slavery is mirrored in the 13th Amendment of the US Constitution. Ratified following the Civil War with the purpose of freeing African Americans, the loophole of allowing unpaid, forced labor as punishment has been seen by many as a way to abuse human rights in a completely legal, modern way. This reason, among others, has made the use of prison labor extremely controversial in the US, so Colorado’s actions to reduce it may have a ripple effect on like-minded states. Now that Colorado has effectively removed this caveat, the passed initiative’s impact on labor contracts in state-owned public prisons and private prisons – an industry that brings in over $2 billion annually – remains to be seen.

In addition to prison reform, five states approved a set of crime victim protections known collectively as Marsy’s Law. Named for Marsalee “Marsy” Nicholas who was murdered by her ex-boyfriend in 1983, the laws provide protections for victims and their families through measures such as giving notice when the accused is released, the right to attend public proceedings involving the accused perpetrator, the right to speak at such hearings when they involve sentencing or pleads proceedings, and the right to receive restitution from the accused, among several other actions. The goal, activists posit, is to give crime victims the protection and dignity that criminals are afforded by the Constitution. Florida, Georgia, Nevada, North Carolina, and Oklahoma passed Marsy’s Law ballot initiatives, joining California, North Dakota, South Dakota, Illinois, and Indiana.

As positive as these reforms appear, organizations like the ACLU suggest that Marsy’s Law is a threat to the accused’s right to due process. As they see it, Marsy’s Law is focused on the rights individuals have against another individual, whereas the criminal protections that Marsy’s Law is trying to parallel are focused on protecting criminals from abuse by the state. When defendants have the added complication of individual-to-individual interactions and accused-to-government interactions, it can ultimately undermine their case. The “abstract” nature of Marsy’s Law can also cause interpretation problems down the line, problems that South Dakota is now facing as it tries to amend the law’s language for clarity and bureaucratic simplicity. For victims, the adoption of Marsy’s Law in five more states is a win, but for the criminal justice as a whole, it may create more problems than it solves.

Health Care

Idaho, Nebraska, and Utah voters passed Medicaid expansion measures on Tuesday. Approximately 300,000 Americans are set to benefit from these expansions and receive health care in the three states. While similar health care measures have been passed in states like Maine, implementation has experienced speed bumps when anti-expansion politicians stand in the way.

Provisions of the Affordable Care Act, including pushing for the expansion of Medicaid, have become a widely accepted part of health care coverage in the United States. Health care itself was a top motivator for voters in the midterms. Often, policies that expand the government safety net are positively received by voters, even if they are not well-received by politicians. In a Pew Research Center study, 60% of Americans said they believed ensuring health care coverage is the government’s responsibility; while support for a single-payer system varied, mainly along party lines, almost all Americans, regardless of political affiliation, believe that government should be involved with providing health care – a mere 4% said the industry should be totally privatized. This polling and the general attitude of voters in the 2018 midterms show the growing importance of health care as a government issue and, one way or another, that voters will support measures to expand public care such as Medicaid.

Overall, the focus on ballot measures in this election could be indicative of a larger trend: as the country becomes more polarized and citizens become increasingly dissatisfied with their elected representatives, localized attempts at policy-making will become the norm. Rather than waiting years for federal policy to go their way on an issue, be it abortion or criminal justice, people are taking policy into their own hands at the state level, making changes that many feel politicians cannot or will not. If the public remains disappointed in the federal government’s performance, we can expect to see an increased reliance on ballot initiatives as a way to legislate.