Once the dust began to settle from the 2016 election, political pundits and many in the HIV community began to look ahead to the 2018 midterm elections.

However, while the 470 House and Senate seats that will be up for grabs in November are of importance in general and HIV policy in specific, a number of ballot initiatives could have an effect on people living with HIV.

Medicaid Expansion Goes West: In all likelihood, residents in three very red states will be voting on whether to expand Medicaid. It will be on the ballot in both Utah and Idaho, with Nebraska expected to see its expansion initiative given the green light by the state’s board of elections.

At a time when the Trump administration is undermining the Affordable Care Act and saddling existing Medicaid expansion programs with onerous work requirements, it is a promising sign that states with heavily Republican voter bases are at the very least considering expanding Medicaid.

In 2016, voters in the slightly bluer but still largely GOP-led state of Maine overwhelmingly supported a ballot initiative to expand Medicaid in the state. Unfortunately, Maine’s soon-to-be-departing Republican Governor Paul LePage has fought its implementation.

Should voters in Idaho—the most conservative of the three states considering Medicaid expansion in November—support the ballot initiative, the state’s Republican gubernatorial candidate Brad Little has already said he “will adhere to the will of the voters.”


Transgender Rights in Massachusetts: State residents will be asked to vote on a veto referendum concerning an already passed piece of legislation (Senate Bill 2407) barring discrimination based on gender identity in public spaces, such as hotels, restaurants and stores.

The referendum was spearheaded by the right-wing, religious “Keep MA Safe” campaign and the Massachusetts Family Institute, which has routinely demonized trans individuals in its promotional material, referring to those in the trans community as performing “sexual charades.” The campaign also engaged in fearmongering to claim that the right of a trans person to use the bathroom of their choice is a grave threat to the safety of women and girls everywhere. A recent poll shows that only 38 percent of voters supported repealing the law.

Abortion in Alabama & West Virginia: Voters will face ballot initiatives that would add antiabortion language to their state constitutions and potentially have a huge effect on access to abortion should the federal protections offered by Roe v. Wade be overturned or weakened in the coming years.

In West Virginia, the ballot initiative would amend the state’s constitution to say that “nothing in this Constitution secures or protects a right to abortion or requires the funding of abortion,” nullifying a 1993 state Supreme Court decision affirming the right to both abortion care and Medicaid funding for abortion.

Alabama’s measure would be less impactful in the short term but farther-reaching. In their ballot initiative, Alabama abortion opponents want to add language to their state constitution “to recognize and support the sanctity of unborn life and the rights of unborn children, including the right to life.”

Regardless of their success this November, abortion rights experts believe that ballot initiatives of this sort will be seen with increasing frequency in future elections in states that are already hostile toward a woman’s right to choose.