FILE - A man wears stickers after casting his ballot at the Hamilton County Board of Elections in Cincinnati, Oct. 10, 2018. In addition to choosing candidates, voters are deciding ballot initiatives.
FILE - A man wears stickers after casting his ballot at the Hamilton County Board of Elections in Cincinnati, Oct. 10, 2018. In addition to choosing candidates, voters are deciding ballot initiatives.

Voters participating in U.S. midterm elections next week will be choosing more than candidates, they’ll also be weighing in on 155 statewide measures across 37 states, according to Ballotpedia, an online nonpartisan political resource.

Of the 155 ballot measures, which cover topics from health care to climate change to taxes, 68 are initiatives, meaning citizens bypassed their state legislatures by gathering enough signatures to put their measures on the ballot.

Historically, ballot initiatives in the U.S. have been used as a way for citizens to exercise their political voice. In recent years, as the country’s legislative bodies have become more divided, it has been a way for citizens to take action outside of their state legislatures.

Here are some of the topics voters face:

Florida: Felon voting rights

What it is: Amendment 4 would restore voting rights to felons in Florida, one of four states that disenfranchise felons permanently. If passed, the Sunshine State would gain 1.5 million voters, possibly the largest single expansion of democratic rights in the U.S. since the voting age was lowered to 18 in 1971.

For: A collection of civil rights organizations like the American Civil Liberties Union and mostly democratic politicians and activists, who say the current law is both unfair and disproportionately impacts African-Americans. The ballot has drawn attention on a national scale, with household names like Bernie Sanders and John Legend throwing their weight behind the measure.

Against: A handful of local conservative politicians. Nonpartisan political resource Ballotpedia has recorded no opposition committees being formed. Local nonprofit Floridians for a Sensible Voting Rights Policy was formed to oppose the measure.

FILE - A patient undergoes dialysis at a clinic in
FILE - A patient undergoes dialysis at a clinic in Sacramento, Calif., Sept. 24, 2018. Of the eight initiatives on California's Tuesday ballot, the costliest thus far is Proposition 8, a measure that would cap profits for dialysis clinics.

?California: Dialysis profits

What it is: A spat between the state’s major dialysis providers and a health care union has evolved into a more than $100 million fight over a ballot measure that could have serious ramifications for California’s roughly 80,000 dialysis patients who need the blood-purifying treatment to live.

Proposition 8 would limit the amount of money that dialysis companies can make in California to 15 percent over operating costs, with anything more being cycled back to pay health insurance rebates, improve clinic quality and hire more workers.

For: Leading supporter and bill sponsor Service Employees International Union-United Healthcare Workers West (SEIU-UHW), a labor organization for medical employees, says the measure is about channeling revenue from a multibillion-dollar industry back into patient care.

Advocates have called concerns about clinic closures a scare tactic propagated by dialysis companies.

"They are not at risk of closing clinics," Sean Wherley, spokesperson for the Yes on Prop 8 campaign, told VOA News. "They have the money. Now they just need the will to invest it in the care like they should have long ago."

Against: Critics, led by major dialysis providers, said the proposition would lead to the closing of clinics, which would endanger the lives of California’s roughly 80,000 dialysis patients by making treatment, already time-consuming and expensive, harder to obtain.

"We believe that Proposition 8 will lead to dialysis clinics closing and patients losing access to dialysis treatments. And this jeopardizes their lives, obviously," Kathy Fairbanks, spokesperson for No on Prop 8, told VOA News.

A worker weighs a sample of marijuana for inventor
A worker weighs a sample of marijuana for inventory purposes at Utopia Gardens, a medical marijuana dispensary, in Detroit, Oct. 2, 2018. Michigan and North Dakota, where voters previously authorized medical marijuana, will decide now if the drug should be legal for any adult 21 and older. They would become the 10th and 11th states to legalize so-called recreational marijuana since 2012.

?Midwest: Marijuana

What it is: Michigan and North Dakota could become the first Midwest states to legalize recreational marijuana.

For: Supporters say the measure would prevent law enforcement resources from being wasted policing the substance and instead create revenue for the state’s roads, schools and local government.

"Their reasoning is based on the assumption that (with legalization) use increases, and everyone is going to start smoking marijuana," Josh Hovey of The Coalition to Regulate Marijuana Like Alcohol, Michigan’s pro-pot campaign, told VOA News. "The fact is that marijuana is here in Michigan. It’s going to be here whether Proposal One passes or not."

Against: Sheriffs in nearly 60 of Michigan’s 83 counties issued a statement condemning the resolution, and various law enforcement organizations have spoken out against legalizing marijuana in North Dakota.

Critics, led by opposing campaign Healthy and Productive, have expressed concerns about the health effects of marijuana. Some, like former Michigan state Senate Republican Majority Leader Randy Richardville, worry that becoming the only recreational pot state in the region could attract drug dealers, citing reports of foreign gangs setting up shop in states like Colorado where cannabis is legal.

Maine: Universal home care

What it is: A proposal would bring universal home care to seniors and those with disabilities, regardless of income level.

The measure would be paid for by a 3.8 percent tax on individuals earning more than $128,000 a year.

For: Proponents have brushed aside concerns about cost, saying the measure is a necessary move for a state with the oldest median population in the country.

"It costs half as much to help someone stay at home as it does to put them into a nursing home," said Mike Tippling of Mainers for Homecare, the pro-initiative campaign. "That’s one of the reasons that the nursing homes are so against this measure, and they’ve been spending so much money spreading so many lies about it."

Against: Critics, led by local hospice and health care providers, have said this won’t be enough to cover the expansive definition of home care outlined in the proposal, requiring massive new tax increases to avoid leaving elderly and disabled people wait-listed for critical services.

"Businesses recognize what an absolute economy killer this would be for our state if we were to become the highest taxed state in the country," Newell Augur, a director at the Home Care and Hospice Alliance and head of the Stop the Scam opposition campaign, told VOA.

Louisiana: Non-unanimous Juries

What it is: A proposed amendment would require unanimous votes by jurors to convict people who are being charged with felonies. Louisiana and Oregon are the only two states to allow split juries to hand down felony convictions.

Amendment 2 would require the unanimous agreement of jurors to convict people charged with felonies. As of 2018, Louisiana requires the agreement of 10 out of 12 jurors, or 83 percent, to convict people charged with felonies. Amendment 2 would not affect juries for offenses that were committed before Jan. 1, 2019.

For: Amendment supporters say this gives the state’s largely white juries an advantage over African-American juries and African-American defendants.

An investigation published by the New Orleans Advocate in April found that while juries are disproportionately white, defendants are disproportionately black. The newspaper found that state prosecutors tended to reject prospective African-American jurors during the selection process because black jurors are 2.5 times as likely as white jurors to dissent in split convictions. The investigation found that there were about 2,000 inmates serving life sentences based on non-unanimous verdicts.

Against: Few in the state have actively opposed the ballot measure. Some officials, such as Louisiana Attorney General Jeff Landry and Pete Adams, of the Louisiana District Attorneys Association, have defended the practice as a means of increasing the efficiency of the state’s courts, saying the amendment would result in more hung juries and retrials.


FILE - A yard sign promoting Initiative 427, the M
FILE - A yard sign promoting Initiative 427, the Medicaid Expansion Initiative, is seen in Omaha, Neb., Oct. 17, 2018. For nearly a decade, opposition to Obama's health care law has been a winning message for Nebraska Republicans, helping them take every statewide office, dominate the Legislature and hold all of the state's congressional seats.

Affordable Care Act (ACA) Medicaid expansion

What it is: A provision to extend Medicaid coverage to people under the Affordable Care Act, also known as Obamacare.

Other than a 2016 measure in Maine, this will be the first time since 2012 that a state ballot concerning the ACA has been voted on, partially because of reduced support from the federal government. Three states, Idaho, Nebraska and Utah, are voting on measures.

For: Progressive citizens. "Those are to increase coverage and provide additional funding mechanisms to cover the state’s portion of the increasing costs, per Obamacare’s provisions, as the federal government’s portion decreases," Josh Altic of Ballotpedia told VOA News.

Against: Conservative state governments that declined to expand Obamacare in the first place.

Redistricting, voting access and campaign spending

The trend: The biggest issue for voters this year is election policy, with 20 measures in 15 states.

• Four states will decide whether to establish new redistricting systems for their state legislatures.

• Several measures will tighten or ease access to the polls for citizens by increasing ID requirements or simplifying registration, a move many say is a partisan tactic to boost conservative and liberal showings at the polls.

• Other states will seek to redefine the role money plays in their elections. North Dakota’s Measure 1 would ban foreign political contributions, while Amendment 75 in Colorado aims to prevent wealthy individuals from buying elections by vastly increasing the money candidates may accept in elections where a candidate gives more than $1 million of their own money to their campaign.

Oregon Gov. Kate Brown, left, poses for photos wi
Oregon Gov. Kate Brown, left, poses for photos with supporters after a rally in Portland, Ore., Oct. 17, 2018. A measure to ban the use of state funds to pay for abortions is on the ballot in Oregon, the state with the least restrictive abortion laws in the nation.


What it is: Initiatives in three states, Alabama, Oregon and West Virginia, would nearly end abortion in their areas if the federal government ends monetary support.

For: Anti-abortion conservatives anticipating a decrease in federal support or an overturning of Roe v. Wade following the appointment of conservative Supreme Court Justice Brett Kavanaugh.

Against: Pro-choice advocates. "What this amendment is designed to do is to position Alabama to essentially be at the extreme edge of anti-abortion sentiment," Randall Marshall of the American Civil Liberties Union of Alabama told VOA News. "The way the constitutional amendment is written, should the state ever be in a position to restrict abortion, it will do so without regard to any exception whatsoever."