What do you do when your elected representatives ignore the people’s wants and decline to do the people’s business? I’m talking here about simple and direct refusal to enact measures that clear majorities of the voting public want. The good people of the great state of Missouri showed me an excellent answer just last week: you do it yourself.
Missouri is, like Tennessee, one of those deep red states whose GOP lawmakers are beholden to an unrelenting spirit quest aimed at ensuring that the health care demon seed known as Obamacare ends up in the dustbin of history alongside Soviet Communism and eight-track cassette players. That means rejecting, time and time again, the moral and fiscal imperative that is Medicaid expansion, even in the face of strong majority support for it.
Missouri is, unlike Tennessee, a state where with sufficient motivation (of the outrage kind) and elbow grease, voters can go around the state legislature, put the damn thing on the ballot, and get it done. And so they did last week, voting to expand Medicaid by a 53-47 percent margin. Hundreds of thousands of low-income Missourians will be added to the ranks of the insured, and because of the federal subsidy involved, tens of millions of dollars in state spending will likely be saved.
Missouri becomes the thirty-eighth state to expand Medicaid, coming on the heels of even redder Oklahoma, whose voters approved expansion earlier this summer. They are the fifth and sixth states to rebuke their obstreperous governors and legislatures and get this accomplished by ballot initiative (joining Maine, Nebraska, Utah, and Idaho).
Could Tennessee become the seventh? No, not now, not ever. We don’t do ballot initiatives; mommy won’t let us. By mommy I mean, of course, the drafters of the Tennessee state constitution, which makes no allowance for the citizen-activated processes of initiative and referendum. Proposed constitutional amendments do go before voters, but only after supermajority approval by the legislature (or if the legislature calls a constitutional convention).
Half the states allow ballot initiatives, although types and procedures vary (an outfit called the Initiative & Referendum Institute tracks it all here), and they’ve been around for quite a while—starting with South Dakota, nineteen launched them between 1898 and 1918. The most recent state to amend its constitution to allow initiatives was Mississippi in 1992. According to the folks at the online electoral almanac Ballotpedia, there have been around 14,000 ballot measures decided by voters since 1900, 61 percent of which were approved.
Lots of people don’t like these things. In some states that have been at it a while with manageable hurdles for getting on the ballot—Washington and Colorado come to mind—there have been hundreds of such measures. As with everything else in American politics, we should follow the money as special interests spend big to push pet issues the public barely understands, or to put hot-button issues on the ballot to juice turnout that benefits particular candidates. There are legitimate concerns that the process is too easily hijacked to exercise majority tyranny at the expense of individual rights and liberties. In a country with a working system of representative government, the argument goes, direct democracy is a bug, not a feature.
I have listened to civic-minded friends in initiative-happy states whine about the ballot excess they must endure—the burden of coming up to speed on this or that issue when the people elected to a legislature ought to just do their jobs and deal with it themselves. But while the various arguments against ballot initiatives have merit, life in a state like Tennessee with a dysfunctional political culture that is blind to both public need and public opinion has a way of diluting the force of those arguments.
It is worth acknowledging that these Medicaid expansion initiatives like the one in Missouri are not purely home-grown grassroots affairs. A national labor-backed nonprofit called the Fairness Project, which funds and supports ballot measures on progressive issues, played a significant role in all six of the states that have expanded Medicaid through the ballot. The Project has also backed initiatives in various states aimed at raising minimum wages, implementing sick leave policies, and capping payday loan interest rates. Arkansans used the ballot to overwhelmingly raise their minimum wage two years ago; Tennesseans will never get the chance.
Joshua Dyck and Edward Lascher Jr., political scientists who wrote a book last year taking a close look at the effects of direct democracy, concluded that “the initiative process mainly encourages greater conflict rather than produces political and social benefits.” I’m guessing that 300,000 Missourians who now stand to gain health insurance coverage might beg to differ.