Oregon Measure 111, Right to Healthcare Amendment (2022)

Oregon Measure 111
Election date November 8, 2022
Topic Healthcare
Status a Approved
Type Constitutional amendment	Origin State legislature

Oregon Measure 111, the Right to Healthcare Amendment, was on the ballot in Oregon as a legislatively referred constitutional amendment on November 8, 2022. The ballot measure was approved.

A "yes" vote supported amending the state constitution to require that the state "ensure that every resident of Oregon has access to cost-effective, clinically appropriate and affordable health care as a fundamental right."

A "no" vote opposed amending the state constitution to require that the state "ensure that every resident of Oregon has access to cost-effective, clinically appropriate and affordable health care as a fundamental right."

Election results

Oregon Measure 111
Result		Votes	Percentage
Yes		951,446	50.73%
No		924,231	49.27%

Results are officially certified.

Source

Overview

What did Measure 111 do?

See also: Text of measure

Measure 111 added a section to the Oregon Constitution establishing a right to "cost-effective, clinically appropriate and affordable health care" for every Oregon resident. The amendment required the state to balance the obligation of ensuring a right to healthcare against funding public schools and other essential public services. The amendment stated that legal remedies for lawsuits brought against the proposed section may not interfere with the balance between a right to healthcare and funding other essential public services.

This was the first amendment adopted by any state to secure a right to affordable healthcare for all state residents. Click here to see what other state constitutions say about health and healthcare.

What did supporters and opponents say?

See also: Support and Opposition

Rep. Andrea Salinas (D), who voted in support of the bill, said, "We need to send this to the voters because of the unpredictability of the future of health care at the federal level. The marketplace needs some stability, and the state of Oregon needs a path forward. We don’t need better insurance instruments, we need better access to health care."

Senate Minority Leader Fred Girod (R), who voted against the bill, said, "This bill promises something that Democrats know they can’t deliver. The bill doesn’t fund any system to deliver on that promise. If Democrats are serious about giving Oregonians free health care, they should come up with an actual plan. This kind of lazy policymaking lacks important details Oregon voters need to make an informed decision at the ballot box."

How did Measure 111 get on the ballot?

See also: Path to the ballot

Measure 111 was introduced as Senate Joint Resolution 12 (SJR 12) on January 11, 2021. On March 18, 2021, the state Senate passed SJR 12 in a vote of 17-13. All but one Democrat voted in favor of the amendment, and the sole independent and one Democratic senator, Sen. Betsy Johnson, joined Republican senators in voting against the measure. On May 19, 2021, the House approved SJR 12 by a vote of 34-23 with three excused. The vote was along party lines with Democrats supporting the amendment, and Republicans opposing the amendment.

The amendment has been introduced at least eight times in the last 16 years according to Oregon Public Broadcasting. It was last introduced during the 2020 legislative session. It was approved largely along party lines in the Oregon House of Representatives by a vote of 36-21 with three excused. One Democrat joined the Republican minority in the vote. It did not receive a vote in the Oregon State Senate due to a legislative walkout.

Text of measure

Ballot title

The ballot title was as follows:

“

Amends Constitution: State must ensure affordable healthcare access, balanced against requirement to fund schools, other essential services Result of 'Yes' Vote: 'Yes' vote requires state to ensure affordable healthcare access. State must balance healthcare funding against funding for schools, other essential services; courts must respect balance. Result of 'No' Vote: 'No' vote retains current law. The constitution does not require the state to ensure access to affordable health care; state provides some healthcare access.

”

Ballot summary

The ballot summary was as follows:

“

Amends Constitution. Current state law outlines the general requirements for health insurance policies and provides health care for low income and disabled residents who meet eligibility requirements. Amends the Oregon Constitution to establish health care as a fundamental right; obligates the state to provide Oregon residents “access to cost-effective, clinically appropriate and affordable health care.” Amendment requires the state to balance that obligation against the public interest in funding public schools and other essential public services. If the state is sued to enforce the amendment, the court may not order a remedy that interferes with the state’s requirement to balance healthcare funding against funding for public schools and other essential public services.

”

Constitutional changes

See also: Article I, Oregon Constitution

Measure 111 amended Article I of the state constitution. The following underlined text was added:

SECTION 47. (1) It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, clinically appropriate and affordable health care as a fundamental right. (2) The obligation of the state described in subsection (1) of this section must be balanced against the public interest in funding public schools and other essential public services, and any remedy arising from an action brought against the state to enforce the provisions of this section may not interfere with the balance described in this subsection.

Readability score

See also: Ballot measure readability scores, 2022

Using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) formulas, Ballotpedia scored the readability of the ballot title and summary for this measure. Readability scores are designed to indicate the reading difficulty of text. The Flesch-Kincaid formulas account for the number of words, syllables, and sentences in a text; they do not account for the difficulty of the ideas in the text. The attorney general wrote the ballot language for this measure.

The FKGL for the ballot title is grade level 9, and the FRE is 50. The word count for the ballot title is 74.

The FKGL for the ballot summary is grade level 14, and the FRE is 30. The word count for the ballot summary is 113.

Support

Right to Health Care led Vote Yes on Measure 111 campaign.

Supporters

Officials

• U.S. Sen. Jeff Merkley (D)
• State Sen. Elizabeth Steiner Hayward (D)
• Senate Majority Leader Rob Wagner (D)
• State Rep. Rob Nosse (D)
• State Rep. Rachel Prusak (D)
• State Rep. Andrea Salinas (D)

Unions

• AFSCME, Oregon
• Oregon AFL-CIO
• Oregon Academy of Family Physicians
• Oregon Education Association
• Oregon Federation of Nurses and Health Professionals
• Oregon Nurses Association

Organizations

• ACLU of Oregon
• League of Women Voters of Oregon
• Planned Parenthood PAC of Oregon
• SEIU Oregon

Arguments

• League of Women Voters of Oregon: "The HOPE Amendment [SJR 12] is simply an aspirational bill that asks two basic questions: Is health care a right or is it a privilege? Is Oregon committed to ensuring that every individual has access to some form of health insurance as it is afforded in every other modern country?"
• State Rep. Rob Nosse (D): "Burdensome medical bills, or medical conditions that go untreated because of a lack of financial resources, cause great strain to families and individuals all over this state. They hold people back, causing them to forego starting a business, getting an education, buying a home, or having children. This amendment is a practical and sober statement of what the people of this state need."
• State Rep. Andrea Salinas (D): "We need to send this to the voters because of the unpredictability of the future of health care at the federal level. The marketplace needs some stability, and the state of Oregon needs a path forward. We don’t need better insurance instruments, we need better access to health care."
• Sen. Elizabeth Steiner Hayward (D): "If the COVID-19 pandemic has taught us anything, it is that without access to high-quality, affordable healthcare our communities cannot thrive. Oregon has always been a national leader in healthcare which is why I chose Oregon for my family medicine training. ... Enshrining healthcare as a right in our constitution is the next logical step in protecting healthcare access."
• Charles E Swanson, Health Care for All Oregon-Action: "Oregon can ensure this fundamental right with a proven, cost-effective system. Countries around the world have implemented single-payer healthcare systems that meet these criteria with simplified, transparent practices, and greatly expanded patient choice. These countries spend much less per person than the complex U.S. system. And they get better health outcomes."

Opposition

Opponents

Officials

• State Sen. Fred Girod (R)
• State Rep. Ron Noble (R)
• State Rep. Kim Wallan (R)

Arguments

• Senate Minority Leader Fred Girod (R): "This bill promises something that Democrats know they can’t deliver. The bill doesn’t fund any system to deliver on that promise. If Democrats are serious about giving Oregonians free health care, they should come up with an actual plan. This kind of lazy policymaking lacks important details Oregon voters need to make an informed decision at the ballot box."
• Samuel Metz, a retired anesthesiologist and vice president of Physicians for a National Health Program/Oregon: "This is not a foundation. It is not a stepping stone. It creates obstacles that may ironically render Oregon as the only state where single payer is prohibited. ... Measure 111 offers no benefit, only risks. In medicine, any risk is unacceptable if there is no benefit."
• State Rep. Kim Wallan (R): "This requires the state to force some people to provide health care to others. It means the state will have to send doctors and nurses to remote areas, at a salary set by the state, to give everyone their right to health care. After all, if you have a right to have health care, how are you going to get it if someone else doesn't give it to you? In fact, to those obligated to provide the service, and to those obligated to pay for it, it is the opposite of a freedom. It is coercion. Supporters say that this measure does not force the state to spend any money on it, and that the courts cannot force it to. They know health care for all equals the entire state budget, so they essentially say that it is only a virtue signal, with no strings attached."

Campaign finance

See also: Campaign finance requirements for Oregon ballot measures

The campaign finance information on this page reflects the most recently scheduled reports processed by Ballotpedia, which covered through December 31, 2022.

One committee was registered in support of Measure 111—Right to Healthcare PAC. It reported $98,104.83 in contributions. Ballotpedia also identified a committee—Oregon Votes Yes—that registered in support of all four 2022 ballot measures. It reported $785,950.24 in contributions.

	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Support	$869,267.00	$14,788.07	$884,055.07	$867,663.01	$882,451.08
Oppose	$0.00	$0.00	$0.00	$0.00	$0.00

Support

The following table includes contribution and expenditure totals for the committee in support of the initiative.

Committees in support of Measure 111
Committee	Cash Contributions	In-Kind Contributions	Total Contributions	Cash Expenditures	Total Expenditures
Oregon Votes Yes	$785,922.00	$28.24	$785,950.24	$785,440.32	$785,468.56
Right to Healthcare PAC	$83,345.00	$14,759.83	$98,104.83	$82,222.69	$96,982.52
Total	$869,267.00	$14,788.07	$884,055.07	$867,663.01	$882,451.08

Donors

The following were the top donors to the committee:

Donor	Cash Contributions	In-Kind Contributions	Total Contributions
National Education Association	$500,000.00	$0.00	$500,000.00
Oregon Education Association	$75,000.00	$0.00	$75,000.00
Oregon Progressive Alliance	$50,000.00	$0.00	$50,000.00
Nurses United Political Action Committee (12987)	$20,000.00	$0.00	$20,000.00
SEIU 49 Political Action Fund (19181)	$10,000.00	$3,000.00	$13,000.00

Media editorials

See also: 2022 ballot measure media endorsements

Ballotpedia identified the following media editorial boards as taking positions on Measure 111.

Ballotpedia lists the positions of media editorial boards that support or oppose ballot measures. This does not include opinion pieces from individuals or groups that do not represent the official position of a newspaper or media outlet. Ballotpedia includes editorials from newspapers and outlets based on circulation and readership, political coverage within a state, and length of publication. You can share media editorial board endorsements with us at editor@ballotpedia.org.

Support

• Portland Tribune Editorial Board: "Yes ... If there was any doubt before COVID-19 hit, Oregon still has some work to do to ensure that all residents have equal access to quality, affordable health care. This constitutional change will not magically make that happen, but it will ensure that when balancing the needs of Oregonians, health care will continue to be part of the equation, as is education and public safety. It does not impose any new taxes, nor any requirements on employers or individuals. It does, however, give advocates for equitable health care."
• Eugene Weekly Editorial Board: "Measure 111, YES. ... According to the Oregon Voters’ Pamphlet, the measure’s financial impact 'will depend on future legislative action to establish additional health benefits and determine how they will be paid for.' We’re betting that giving all Oregonians access to affordable health care saves money in the end, and we know it’s the right thing to do."
• Portland Mercury Editorial Board: "Would the passage of Measure 111 mean Oregon suddenly becomes a mini-Canada with free healthcare raining from the sky? No. But its passage opens the door for legislators to make rules that may bring us closer to that utopia—but that can’t happen unless we all agree affordable healthcare is a fundamental right. In short, we have to take this step in order to take future steps, which means voting in favor of Measure 111 is a vote for the health and welfare of all Oregonians."

Opposition

• Yambill County's News-Register Editorial Board: "Measure 111, a legislative referral aimed at establishing a constitutional right to adequate and affordable healthcare, is also drawing campaign fire. It is largely aspirational rather than operational. ... That makes our call no on 111."
• The Oregonian Editorial Board: "[V]oters should resist the emotional pitch of the measure and recognize the legal and political morass that this proposed constitutional amendment could trigger. Referred to voters by a split Legislature, this amendment – the first in the nation with such an explicit requirement – could open the door to lawsuits seeking to define what such an obligation owed to every resident looks like. It also can increase pressure to raise new taxes in the future to fund these undefined goals. There is no reason that legislators need Measure 111 to meet this supposedly aspirational goal, except as a way to leverage more money in the future. Oregonians should vote no."
• The Corvallis Advocate Editorial Board: "We’re voting 'No' because we’d prefer a proposal that actually delivers a healthcare system. In short, we appreciate the sentiment, but what we want is a plan."

Background

Previous attempts to place the amendment on the ballot

The amendment had been introduced at least eight times in the last 16 years according to Oregon Public Broadcasting. During the 2020 legislative session, Rep. Mitch Greenlick (D) proposed the amendment. It was approved largely along party lines in the Oregon House of Representatives by a vote of 36-21 with three excused. One Democrat joined the Republican minority in the vote. It did not receive a vote in the Oregon State Senate due to a legislative walkout. On February 24, 2020, 11 of the 12 Republican members of the Senate did not attend the regularly scheduled morning Senate floor session. Democrats held 18 seats, two short of the 20 members needed for a quorum. On March 5, Senate President Peter Courtney (D) and House Speaker Tina Kotek (D) adjourned their respective chambers early due to the lack of quorum.

Healthcare coverage in Oregon

In 2019, the uninsured rate of the civilian noninstitutionalized population in Oregon was 7.2% according to the U.S. Census Bureau. This was 2.0% lower than the national uninsured rate of 9.2%.

The following map shows the rate of uninsured in each state in 2019. Massachusetts had the lowest rate of uninsured with 3%, and Texas had the highest rate of uninsured with 18.4%.

Healthcare expenditures per capita by state

In 2014, healthcare costs per capita in Oregon were $8,044 according to data from the Centers for Medicare and Medicaid Services and the Kaiser Family Foundation. This was below the national average of $8,278 per capita. The state with the lowest costs per capita was Utah with $5,982. The state with the highest costs was Massachusetts with $10,559 per capita. However, Washington D.C. exceeded Massachusetts with healthcare costs of $11,944 per capita. The map below illustrates the healthcare expenditures per capita by state residence. Scroll over the state to see its respective cost per capita.

State constitutional provisions related to health

Oregon became the first state to establish a right to affordable healthcare for all state residents in its constitution if the amendment is adopted. The constitutions of Arkansas, Indiana, and Mississippi establish a legislative duty to provide care for "the deaf, the mute, and the blind; and, for the treatment of the insane" and "the indigent sick." The constitutions of Illinois and Montana make it a duty of the state and individuals to provide for a "healthful environment." The remaining state constitutions listed below reference "public health" and "general welfare" as matters of public concern or vital interests to the state.

Ballotpedia identified the following provisions in state constitutions that concern health and healthcare:

State	Constitution	Language
Alabama	Multiple amendments	"so as to promote the public health and general welfare"
Alaska	Article VII, Section 4	"The legislature shall provide for the promotion and protection of public health."
Arkansas	Article 19, Section 19	"It shall be the duty of the General Assembly to provide by law for the support of institutions for the education of the deaf and dumb, and of the blind; and also for the treatment of the insane."
Illinois	Article XI	"The public policy of the State and the duty of each person is to provide and maintain a healthful environment for the benefit of this and future generations. The General Assembly shall provide by law for the implementation and enforcement of this public policy. Each person has the right to a healthful environment."
Indiana	Article 9, Section 1	"It shall be the duty of the General Assembly to provide, by law, for the support of institutions for the education of the deaf, the mute, and the blind; and, for the treatment of the insane."
Louisiana	Preamble	"We, the people of Louisiana, grateful to Almighty God for the civil, political, economic, and religious liberties we enjoy, and desiring to protect individual rights to life, liberty, and property; afford opportunity for the fullest development of the individual; assure equality of rights; promote the health, safety, education, and welfare of the people..."
Michigan	Article IV, Section 51	"The public health and general welfare of the people of the state are hereby declared to be matters of primary public concern. The legislature shall pass suitable laws for the protection and promotion of the public health."
Mississippi	Article IV, Section 86	"It shall be the duty of the legislature to provide by law for the treatment and care of the insane; and the legislature may provide for the care of the indigent sick in the hospitals in the state."
Missouri	Article IV, Section 37	"The health and general welfare of the people are matters of primary public concern; and to secure them there shall be established a department of social services..."
Montana	Article IX, Section 1	"(1) The state and each person shall maintain and improve a clean and healthful environment in Montana for present and future generations. (2) The legislature shall provide for the administration and enforcement of this duty."
New York	Article XVII, Section 3	"The protection and promotion of the health of the inhabitants of the state are matters of public concern and provision therefore shall be made by the state and by such of its subdivisions and in such manner, and by such means as the legislature shall from time to time determine."
South Carolina	Article XII, Section 1	"The health, welfare, and safety of the lives and property of the people of this State and the conservation of its natural resources are matters of public concern. The General Assembly shall provide appropriate agencies to function in these areas of public concern and determine the activities, powers, and duties of such agencies."
Wyoming	Article 7, Section 20	"As the health and morality of the people are essential to their well-being, and to the peace and permanence of the state, it shall be the duty of the legislature to protect and promote these vital interests..."

Path to the ballot

See also: Amending the Oregon Constitution

To put a legislatively referred constitutional amendment before voters, a simple majority is required in both the Oregon State Senate and the Oregon House of Representatives.

This amendment was introduced as Senate Joint Resolution 12 on January 11, 2021. On March 18, 2021, the state Senate passed SJR 12 in a vote of 17-13. All but one Democrat voted in favor of the amendment, and the sole independent and one Democratic senator, Sen. Betsy Johnson, joined Republican senators in voting against the measure. On May 19, 2021, the House approved SJR 12 by a vote of 34-23 with three excused. The vote was along party lines with Democrats supporting the amendment, and Republicans opposing the amendment.

Vote in the Oregon State Senate March 18, 2021
Requirement: Simple majority vote of all members in each chamber
Number of yes votes required: 16  a
	Yes	No	Not voting
Total	17	13	0
Total percent	58.6%	44.8%	0%
Democrat	17	1	0
Republican	0	11	0
Independent	0	1	0

Vote in the Oregon House of Representatives May 19, 2021
Requirement: Simple majority vote of all members in each chamber
Number of yes votes required: 31  a
	Yes	No	Not voting
Total	34	23	3
Total percent	56.67%	38.33%	5.00%
Democrat	34	0	3
Republican	0	23	0

How to cast a vote

See also: Voting in Oregon

Click "Show" to learn more about voter registration, identification requirements, and poll times in Oregon.

How to cast a vote in Oregon

Poll times Oregon is an all-mail voting state. Each county provides privacy booths that voters can use to mark their ballot. Typically, voters can return their completed ballot at the same location. Registration Check your voter registration status here. To register to vote in Oregon, one must be a resident of Oregon, a United States citizen, and at least 16 years old. Voters must be at least 18 years old by the day of the election in order to receive a ballot. Potential voters can register online or by mailing in a voter registration form to your county election office. The deadline to register is 21 days before the election. Automatic registration Oregon implemented automatic voter registration in 2016. For more information, click here. Online registration See also: Online voter registration Oregon has implemented an online voter registration system. Residents can register to vote by visiting this website. Same-day registration Oregon does not allow same-day voter registration. Residency requirements To register to vote in Oregon, you must be a resident of the state. Verification of citizenship See also: Laws permitting noncitizens to vote in the United States Oregon does not require proof of citizenship for voter registration. Verifying your registration The Oregon Secretary of State’s Office allows residents to check their voter registration status online by visiting this website. Voter ID requirements Oregon is an all-mail voting state. When registering to vote, voters must provide their driver's license number or state ID card number. If voters can not provide this information, they can print and sign a online voter registration form and mail it to their county election office to complete their registration.

See also

2022 measures

• 2022 ballot measures
• Healthcare on the ballot
• 2022 legislative sessions

Oregon

• Oregon ballot measures
• Oregon ballot measure laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls

External links

• SJR 12 Full Text

Support

• Right to Health Care campaign website
• Right to Health Care Facebook page
• Right to Health Care Twitter page

Opposition

Submit links to editor@ballotpedia.org.