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State Ballot Measures on Environmental Health

November 11, 2022

On November 8, 2022, voters in the U.S. decided on 133 state ballot measures, including several that addressed water, climate change, health, and cannabis.
Most measures get on the ballot in one of two ways: 1) through a citizen initiative where citizens have an idea for a statutory or constitutional change and gather signatures to place it on the ballot or 2) through a referral to the ballot from the legislature. Occasionally, voters try to repeal a law passed by the legislature, which is known as a popular referendum or people's veto.
In 2022, voters across the nation saw:
  • 104 legislative referrals in 35 states.
  • 29 citizen initiatives in 12 states and Washington, DC.
  • 2 popular referendums in California and Massachusetts.
  • 3 automatic questions in Alaska, Missouri, and New Hampshire that asked voters if they would like to have a constitutional convention.
  • 3 non-binding advisory questions in Idaho (1) and Washington (2). The nonbinding advisory questions in Washington are automatically referred to the ballot whenever the state's legislature passes a bill creating or increasing taxes or fees.
Of these 133 measures, many related to environment and health. Three of measures related to climate change. Two measures in Alabama related to private sewage systems. Many measures addressed cannabis, including five that sought to permit the recreational use of marijuana. Healthcare was on the ballot in three states.


Alabama voters solidly passed Amendment 8 and Amendment 9 that provide for the Public Service Commission to regulate private sewer systems in Shelby, Jefferson and Tuscaloosa Counties. Voters in Louisiana passed Amendment 4 (Waiving Water Charges Measure) that amends the Louisiana Constitution to allow local governments to waive water charges for customers if water leaks or damages to the water system are not caused by the customer.

Climate Change and Environmental Projects

California voters overwhelmingly shot down Proposition 30 (Tax on Income Above $2 Million for Zero-Emissions Vehicles and Wildfire Prevention Initiative) that would have increased the tax on personal income above $2 million by 1.75% and would have dedicated the revenue to zero-emission vehicle projects and wildfire prevention programs.

On the other side of the country, New York voters passed Proposal 1 (Environmental Bond Measure). This measure issues $3 billion in general obligation bonds for projects related to the environment, natural resources, water infrastructure, and climate change mitigation.

Rhode Island voters resoundingly approved Question 3 (Environment and Recreation Bond Measure) that requires the state to issue $50 million in bonds for environmental and recreational purposes. This measure invests in the state's climate action that will mitigate the impacts of climate change through increased investment in green infrastructure.


In Oregon, voters decided on whether to establish a constitutional right (Measure 111) to affordable healthcare. This measure amends the Oregon Constitution to add that the state "ensure that every resident of Oregon has access to cost-effective, clinically appropriate, and affordable healthcare as a fundamental right." As of November 11, the measure is slightly ahead but remains too close to call.

South Dakotans approved a citizen initiative (Constitutional Amendment D) that aims to expand Medicaid. The provision amends the constitution requiring South Dakota to provide Medicaid benefits to adults between 18 and 65 years with incomes below 133% of the federal poverty level. The state becomes the 39th to expand Medicaid in the Affordable Care Act era.

Arizonans passed a citizen initiative (Proposition 209) that would limit interest rates on healthcare debt.


Legalization of cannabis was on the ballot in five states. Voters in Arkansas, North Dakota, and South Dakota rejected the legalization of recreational marijuana. Voters in Maryland and Missouri approved the legalization. In all but Maryland, these measures were citizen initiatives.

Question 4 in Maryland amends the state's constitution to legalize adult-use of recreational marijuana and directs the legislature to pass law for the use, distribution, regulation, and taxation of marijuana.

Missouri's Amendment 3 legalizes the purchase, possession, consumption, use, delivery, manufacturing, and sale of marijuana for personal use for adults over 21 years; allows individuals convicted of nonviolent, marijuana-related offenses to petition to be released from incarceration and/or have their records expunged; and imposes a 6% tax on the sale of marijuana.

Coloradans also narrowly passed an initiative to decriminalize certain psychedelic plants such as psilocybin; the first statewide measure on psilocybin passed in Oregon in 2020.

For more information on the results of the 2022 election related to environmental health, contact Doug Farquhar, NEHA director of Government Affairs, at dfarquhar@neha.org.