As the nation braces for the presidential debate between Vice President Kamala Harris and former President Donald Trump next week, various healthcare topics are expected to be top of mind.

These include the fate of reproductive rights, the future of drug pricing reform as well as the cost and access of healthcare services in general.

Those issues have already seen plenty of spotlight in the national conversation, including at the Democratic National Convention (DNC) and the Republican National Convention (RNC).

However, plenty of impactful healthcare measures will also be voted on at the state level on November 5. 

Here are some of the top health-related measures to keep an eye out for later this fall.

Abortion

Abortion and reproductive rights will remain the key healthcare issue when it comes to both the presidential election as well as individual state ballots.

After the Supreme Court overturned Roe v. Wade in 2022, abortion rights have largely been left to the states. November’s election will determine whether certain states take action to protect abortion rights or if they’ll move toward restrictive laws.

Voters in 10 states will see 11 different abortion-related measures, the most for a single year on record, according to Ballotpedia. 

Nine states, including Arizona, Colorado, Florida and Montana, will vote on measures that will determine a state constitutional right to abortion.

In Colorado, another November measure would create the right to abortion in the state constitution as well as repeal the constitutional provision that bans the use of public funds for abortion. 

Maryland, Missouri, Nebraska, Nevada and South Dakota will all vote on similar measures that will define whether abortion is a constitutional right in those states.

Arizona’s Proposition 139, for example, would define whether the state can provide a fundamental right to abortion before the point of fetal viability — or when a fetus is considered able to survive outside the womb, typically at around 24 weeks of pregnancy.

Florida’s Amendment 4, or the Right to Abortion Initiative, is similar in nature. The measure would protect the right to abortion before fetal viability “or when necessary to protect the patient’s health,” as determined by the patient’s healthcare provider. The amendment would overturn Florida’s current six-week ban on abortion, which was signed into law last year.

Trump, a Florida resident, recently said he would vote “no” on the Florida amendment after initially saying he would support it. Many saw this as part of his efforts to pacify anti-abortion advocates who criticized his initial stance and reiterated calls for a federal abortion ban.

Trump has previously said he doesn’t support a nationwide ban and that he wants to keep the issue to the states.

“Now the states are deciding,” he said in a recent interview with FOX News. “And by the way, in many cases, like Ohio, it became… more liberal or progressive than people would have thought. But the people are now deciding… And in many ways, it’s a beautiful thing to watch.”

Harris, on the other hand, has blamed Trump for mobilizing anti-abortion advocates and claimed that he’s responsible for the overturning of Roe. 

She also pointed to recent ballot initiatives in Kansas, California, Kentucky and Ohio that resulted in voters protecting reproductive rights.

“Since Roe was overturned, every time reproductive freedom has been on the ballot, the people of America voted for freedom,” Harris said.

The Democratic party platform, released last month, listed the reinstatement of Roe as one of Harris’ priorities if she wins the election.

However, any tangible movement on the issue is likely to happen at the state level rather than from 1600 Pennsylvania Avenue for the time being.

IVF

In vitro fertilization (IVF) has become a major healthcare issue in the 2024 elections, after the Alabama Supreme Court ruled in February that embryos created through the procedure should be considered children. 

While the ruling was ultimately stopped from going into effect, it stoked fears that other states would take similar action to restrict IVF access.

Both Trump and Harris have said they would support access to IVF on the federal level — though their approaches are different.

Trump has vowed that he and the Republican party want to make it easier for mothers and families to have babies — not harder — and as a result, he supports access to IVF as a whole. 

Most recently, Trump promised that if he’s elected, his administration would require the government or insurance companies to pay for IVF treatments.

“Because we want more babies, to put it very nicely,” Trump said. “But the IVF treatments are expensive. It’s very hard for many people to do it and to get it, but I’ve been in favor of IVF, right from the beginning.”

Still, Democrats have struck back on Trump’s promises, including Sen. Elizabeth Warren, (D-Mass.), who said in a recent press call that Trump “fools no one.”

“Despite what he seems to think, American women are still not stupid, and we will not trust our futures to the guys who took away legal protection for abortion and IVF,” she said.

Despite debates in the Beltway, there is only one IVF question on a statewide ballot this year. 

In Illinois, voters will decide on a measure called the “assisted reproductive healthcare advisory question,” which will poll people on whether they believe medically assisted reproductive treatments, including IVF, should be covered by any health insurance plan in Illinois that provides full coverage to pregnancy benefits.

Because it’s a non-binding advisory question, however, it won’t define state law — rather, it will help state officials understand public opinion on the matter.

Drug pricing

Harris and the Biden administration may be able to claim responsibility for the passage of the Inflation Reduction Act and its historic drug pricing reform — but the fight to lower prescription drug costs is far from over.

Drug pricing remains a major issue in this year’s elections, with both presidential candidates vowing to enact more reforms if elected.

On the state level, only California will be voting on a drug pricing-related measure. The state’s Proposition 34, if passed, would require healthcare providers to spend 98% of their revenues from the federal discount prescription drug program known as 340B on direct patient care.

Currently, healthcare providers that serve low-income patients can receive a discount on drugs if they’re part of the federal program. Still, those providers can sell the drugs at a higher rate to make a profit.

Proposition 34 would also require the majority of that profit to be spent directly on patient care — if the provider meets certain requirements, including owning a license to operate a health insurance plan, pharmacy or clinic. 

The provider must also have spent more than $100 million on purposes not linked to direct patient care and must own apartments that have received violations. The measure would define those so-called bad actors as “prescription drug price manipulators.”

Marijuana and psychedelics

Notably, four states will be voting on measures related to the use of marijuana and psychedelics, including Florida, Massachusetts, North Dakota and South Dakota.

In Florida, voters will decide on Amendment 3, which would legalize cannabis use in the state for adults over the age of 21. In addition, medical marijuana treatment centers that already exist would be authorized to sell marijuana for personal use (Florida has allowed medical marijuana to be sold since 2016).

North Dakota and South Dakota will both vote on similar measures that would legalize the recreational use of cannabis.

One state, Massachusetts, will vote on a question related to the regulation of psychedelic substances. 

The Bay State’s Question 4 would create a Natural Psychedelic Substances Commission as well as an advisory board that would regulate licensing of the drugs. It would also authorize the personal use of a restricted amount of psychedelics for people over the age of 21.

As research mounts on the use of psychedelics in treating depression and other mental health conditions, advocates like the Massachusetts for Mental Health Options have thrown their support behind Question 4.

To read a September 2024 about Harris and Trump sparring over healthcare in a presidential debate, click here.