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Last Night's Bad News

There’s no denying that last night was a pretty good night for liberals across the country—in MississippiMaine, and especially in Ohio, where voters restored public-sector collective bargaining rights. That was perhaps the night’s most high-profile win, but it wasn’t all good news from the Buckeye State: While voters rejected a right-wing push against unions, they supported one against the Affordable Care Act. By a huge margin, Ohioans approved Issue 3, a symbolic, Tea-Party backed measure to amend the state constitution (and voice conservative protests against the individual mandate). The amendment reads (in part): “No federal, state, or local law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in a health care system.” As Mother Jones reported a few days ago, the amendment won’t affect the ACA (state laws can’t supersede federal law), but its broad language could still have serious unintended consequences. By declaring the unconstitutionality of any law compelling people to participate in a health care system, the amendment could interfere with the state’s ability to carry out myriad health-related actions, from regulating “pill mills” (rogue clinics that unlawfully dole out prescription drugs) to immunizing Ohio’s low-income schoolchildren. Now, the amendment has a vague “cut-off” provision which spares extant laws, but even that provision could prove unable to stop its reach into many longstanding state health practices. It’s too early to see just how this will play out, but last night’s vote raises the question: How many people could be impacted by the amendment’s broad language?

Data from the state of Ohio and the Centers for Disease Control suggest that on the issue of pill mills alone, the number could ultimately reach the thousands. One CDC study of drug overdoses showed that since 1999, the sale of strong painkillers has increased by 300%, fueling a threefold increase in the drug overdose death rate since 1990. And data from Ohio indicates that painkillers were behind nearly 40 percent of the state's roughly 1,300 fatal drug overdoses in 2009. Numbers like that have led to new statewide crackdowns on pill mills, including a law requiring prescribers of certain drugs to report patient and prescription information to a state database. That law is intended to reduce on illicit drug sales, but its effective date is in 2011—after the new amendment’s “cut-off” grace period. That means a key part of Ohio’s anti-pill mill law could now be unconstitutional. That's a high price to pay in order to voice symbolic concerns about the health care law—and it's a reminder that while last night's news may have largely been a relief, it brought new headaches as well.