Ohio Issue 2, Drug Price Standards Initiative (2017)

Ohio Issue 2
Election date November 7, 2017
Topic Healthcare
Status d Defeated
Type State statute	Origin Citizens

2017 measures
November 7, 2017
Ohio Issue 2
Ohio Issue 1

Ohio Issue 2, the Drug Price Standards Initiative, was on the ballot in Ohio as an indirect initiated state statute on November 7, 2017.  The measure was defeated.

A "yes" vote supported this measure to require state agencies and programs to purchase prescription drugs at prices no higher than what the U.S. Department of Veterans Affairs (VA) pays for them.

A "no" vote opposed this measure to require state agencies and programs to purchase prescription drugs at prices no higher than what the VA pays for them.

Election results

Issue 2
Result		Votes	Percentage
d No		1,837,608	79.15%
Yes		483,983	20.85%

Election results from Ohio Secretary of State

Overview

What would Ohio Issue 2 have done?

Issue 2 would have required the state and state agencies, including the Ohio Department of Medicaid, to pay the same or lower prices for prescriptions drugs as the U.S. Department of Veterans Affairs (VA)—a department that negotiates drug prices with companies and typically receives a 24 percent discount for prescription drugs. Specifically, it would have forbidden state agencies from entering into any purchasing agreement with drug manufacturers unless the net cost of the drug was the same or less than that paid by the VA. Issue 2 would have applied in any case in which the state ultimately provided funding for the purchase of drugs, even if the drugs were not purchased directly by a government agency. Examples of such cases include the Ohio Best Rx Program and the Ohio HIV Drug Assistance Program. Issue 2 also would have given the measure’s petitioners a direct and personal stake in defending the law from legal challenges, required the state to pay the petitioners’ reasonable legal expenses, and required the petitioners to pay $10,000 to the state if a court ruled Issue 2 unenforceable.

Was Issue 2 the same as California Proposition 61?

Issue 2 and California Proposition 61 were almost identical. Appearing on California's November 2016 ballot, Proposition 61 was designed to restrict the amount that any state agency could pay for drugs, tying it to the price paid by the VA. While most of the two initiatives' provisions were comparable, Proposition 61 would have exempted Medicaid managed care plans from its drug price regulations, whereas Ohio Issue 2 would not have. The AIDS Healthcare Foundation, the top financial backer of the campaign supporting Issue 2, provided funds for Proposition 61. Voters in California rejected the measure, 53 percent to 47 percent. Opponents raised $109 million in their effort to defeat Proposition 61, while supporters received $19 million. Proposition 61 was the most expensive ballot measure conflict of 2016.

State of the ballot measure campaigns

The combined total raised for and against Issue 2 was $77.41 million, the most funds raised surrounding a ballot measure in Ohio as of 2017. Ohio Taxpayers for Lower Drug Prices, the campaign supporting Issue 2, had raised almost $18.29 million, 99.99 percent of which came from the AIDS Healthcare Foundation. A total of $1.87 million was spent to collect the 184,354 valid signatures required to put this measure before voters, resulting in a cost per required signature (CPRS) of $10.13. The CPRS for California Proposition 61 was $3.36. Opponents organized as Ohioans Against the Deceptive Rx Ballot Issue and raised nearly $59.13 million—100 percent of total funds—from Pharmaceutical Research and Manufacturers of America (PhRMA) and a PhRMA subsidiary.

Points of contention

The following sections summarize the areas of disagreement between the support campaign, Ohio Taxpayers for Lower Drug Prices, and the opposition campaign, Ohioans Against the Deceptive Rx Ballot Issue, regarding Issue 2.

Disclosure of VA drug prices

Issue 2 would have required the state to purchase prescription drugs at prices no higher than what the VA pays for them. To require the state to purchase drugs at prices no higher than the VA, the state would have needed access to information on the amount the VA pays for each drug. Matt Borges, Campaign Manager of Ohio Taxpayers for Lower Drug Prices, said cases in which drug prices are not disclosed are few and far between. He added, "This is something we can absolutely figure out." Dale Butland, Communications Director of Ohioans Against the Deceptive Rx Ballot Issue, disagreed, saying, "If we can't know the lowest price of the VA, then you're setting up a standard that is impossible to meet."

The Plain Dealer and Cleveland.com contacted an official at the VA regarding whether the information was publicly available. The newspapers stated that a VA spokesperson provided an answer: "some pharmaceutical contracts between the VA and private companies are not public record, depending on how the contract is structured." Information on the federally-mandated 24-percent discount was available online. Information on other discounts the VA receives was available or unavailable to the public depending on the contract between the VA and drug manufacturer. The VA spokesperson did not provide the newspapers with the number of drugs with prices not disclosed to the public.

Ohio Issue 2 and VA drug price availability
October 19, 2017: A report funded by Ohio Taxpayers for Lower Drug Prices, which supported the state's ballot measure Issue 2, claimed that it is "unclear" how many VA drug prices are not publicly available, but "it does not seem to be many."
How many VA drug prices are not publicly available? Read Ballotpedia's fact check »

VA drug discounts vs. Ohio drug discounts

The VA received a federally-mandated 24-percent discount on drugs as of 2017. The state government also negotiated drug prices, including for Ohio Medicaid. Dale Butland, communications director of the opposition campaign, said, "Medicaid drugs, which account for 75% of the drugs Ohio buys, already get a 23.1 percent federally-mandated discount. ... and then, just like the VA, Ohio negotiates additional voluntary discounts and rebates with the drug companies." Matt Borges, campaign manager of the support campaign, responded to the claim that the initiative would not decrease drug prices for the state, saying, "If this wouldn’t actually bring prices down in Ohio, which you’re saying it won’t, and it wouldn’t have a ripple effect through the marketplace so people would save money, why would the drug companies have spent $126 million to defeat this issue in California? Why are the drug companies spending $2 million a week to defeat this measure in Ohio?"

Impact on consumers not receiving discounts

Issue 2 would have required state agencies and programs, not private insurance plans, to purchase prescription drugs for the same or lower prices than the VA. Matt Borges of the support campaign and Dale Butland‏ of the opposition campaign disagreed on how Issue 2 would impact consumers who purchase healthcare on the private market or receive healthcare through an employer.

Borges said the initiative would have a "ripple effect through the marketplace," as consumers demand the government to require similar discounts in the private marketplace. He also said Issue 2 would not increase drug prices for individuals and families with private healthcare. He stated, "... when this discount was mandated on the VA, the drug companies didn’t raise prices on everyone else then. You know why? Because they care a lot about the regulatory environment that they’re in."

Butland said the initiative would increase drug prices for consumers with private healthcare, as companies look to make up profits. He stated, "If you tell a company, whether that company makes drugs or whether they make automobiles ... that they have to sell their product to a certain segment of the population at a low price—lower than market price—what happens to prices for people who aren’t covered under that edict? … What I’m telling you is cost shifting isn’t some nefarious scheme dreamed up by the drug companies. It’s basic economics."

Legal defense of Issue 2

Section G of Issue 2 was designed to address legal defense of the measure. Section G states, “... the committee of individuals responsible for the circulation of the [initiative] petition … have a direct and personal stake in defending” the initiative from legal challenges. The committee was composed of four individuals, known as the proponents, including William Booth, Tracy Jones, Latonya Thurman, and Daniel Darland. Booth, Jones, and Thurman were employees of the AIDS Healthcare Foundation.

Ohioans Against the Deceptive Rx Issue, in a campaign fact sheet, said this provision of Issue 2 was unprecedented and would give promoters "the right to intervene at taxpayer expense in any legal challenges that may be filed against it if it becomes law. This provision would give the sponsors a blank check to defend any part of the law, and require that their legal fees be reimbursed by taxpayers whether they win or lose."

Dennis Willard, spokesman for Ohio Taxpayers for Lower Drug Prices, said Section G was included in Issue 2 because "if someone sues — and the only people who would sue would be the drug companies who are trying to protect their profits — the people who spent hundreds of thousands of dollars to save taxpayers $400 million would have a right to be in the courtroom, too."

Does Ohio Issue 2 give promoters the right to defend the law at taxpayer expense?
October 4, 2017: Ohioans Against the Deceptive Rx Issue claims that the ballot initiative Issue 2 includes "an unprecedented provision granting [the promoters] the right to intervene at taxpayer expense in any legal challenges that may be filed against the measure."
Does Issue 2 grant promoters that right? Read Ballotpedia's fact check »

Text of measure

Ballot title

The official ballot title was as follows:

“

Issue 2 Proposed Law Proposed by Initiative Petition To enact Chapter 194 of the Ohio Revised Code A majority yes vote is necessary for the law to pass. To enact Chapter 194 of the Ohio Revised Code, which would: Require the State of Ohio, including its state departments, agencies and entities, to not pay more for prescription drugs than the price paid by the United States Department of Veterans Affairs. Establish that the individual petitioners responsible for proposing the law have a direct and personal stake in defending the law; require the State to pay petitioners’ reasonable attorney fees and other expenses; require the petitioners to pay $10,000 to the State if the law is held by a court to be unenforceable and limit petitioners’ personal liability to that amount; and require the Attorney General to defend the law if challenged in court.

”

Full text

The full text of the measure was as follows:

Chapter 194: Drug Price Relief Section 194.01 (A) Title. This Act shall be known as "The Ohio Drug Price Relief Act" (the "Act"). (B) Findings and Declarations. The People of the State of Ohio hereby find and declare all of the following: (1) Prescription drug costs have been, and continue to be, one of the greatest drivers of rising health care costs in Ohio. (2) Nationally, prescription drug spending increased more than 800 percent between 1990 and 2013, making it one of the fastest growing segments of health care. (3) Spending on specialty medications, such as those used to treat HIV/AIDS, Hepatitis C, and cancers, are rising faster than other types of medications. In 2014 alone, total spending on specialty medications increased by more than 23 percent. (4) The pharmaceutical industry's practice of charging inflated drug prices has resulted in pharmaceutical company profits exceeding those of even the oil and investment banking industries. (5) Inflated drug pricing has led to drug companies lavishing excessive pay on their executives. (6) Excessively priced drugs continue to be an unnecessary burden on Ohio taxpayers that ultimately results in cuts to health care services and providers for people in need. (7) Although Ohio has engaged in efforts to reduce prescription drug costs through rebates, drug manufacturers are still able to charge the State more than other government payers for the same medications, resulting in a dramatic imbalance that must be rectified. (8) If Ohio is able to pay the same prices for prescription drugs as the amounts paid by the United States Department of Veterans Affairs, it would result in significant savings to Ohio and its taxpayers. This Act is necessary and appropriate to address these public concerns. (C) Purposes and Intent. The People of the State of Ohio hereby declare the following purposes and intent in enacting this Act: (1) To enable the State of Ohio to pay the same prices for prescription drugs as the prices paid by the United States Department of Veterans Affairs, thus rectifying the imbalance among government payers. (2) To enable significant cost savings to Ohio and its taxpayers for prescription drugs, thus helping to stem the tide of rising health care costs in Ohio. (3) To provide for the Act's proper legal defense should it be adopted and thereafter challenged in court. (D) Drug Pricing. (1) Notwithstanding any other provision of law and insofar as may be permissible under federal law, neither the State of Ohio, nor any state department, agency or other state entity, including, but not limited to, the Ohio Department of Aging, the Ohio Department of Health, the Ohio Department of Insurance, the Ohio Department of Jobs and Family Services, and the Ohio Department of Medicaid, shall enter into any agreement with the manufacturer of any drug for the purchase of a prescribed drug or agree to pay, directly or indirectly, for a prescribed drug, unless the net cost of the drug, inclusive of cash discounts, free goods, volume discounts, rebates, or any other discounts or credits, as determined by the purchasing department, agency or entity, is the same as or less than the lowest price paid for the same drug by the United States Department of Veterans Affairs. (2) The price ceiling described in subsection (1) above also shall apply to all programs where the State of Ohio or any state department, agency or other state entity is the ultimate payer for the drug, even if it did not purchase the drug directly. This includes, but is not limited to, the Ohio Best Rx Program and the Ohio HIV Drug Assistance Program. In addition to agreements for any cash discounts, free goods, volume discounts, rebates, or any other discounts or credits already in place for these programs, the responsible department, agency or entity shall enter into additional agreements with drug manufacturers for further price reductions so that the net cost of the drug, as determined by the purchasing department, agency or entity, is the same as or less than the lowest price paid for the same drug by the United States Department of Veterans Affairs. (3) All state departments, agencies and other state entities that enter into one or more agreements with the manufacturer of any drug for the purchase of prescribed drugs or agreement to pay directly or indirectly for prescribed drugs shall implement this section no later than July 1, 2017. (4) Each such department, agency or other state entity, may adopt administrative rules to implement the provisions of this section and may seek any waivers of federal law, rule, or regulation necessary to implement the provisions of this section. (5) The General Assembly shall enact any additional laws and the Governor shall take any additional actions required to promptly carry out the provisions of this section. (E) Liberal Construction. This Act shall be liberally construed to effectuate its purpose. (F) Severability. If any provision of this Act, or part thereof, or the applicability of any provision or part to any person or circumstances, is for any reason held to be invalid or unconstitutional, the remaining provisions and parts shall not be affected, but shall remain in full force and effect, and to this end the provisions and parts of this Act are severable. If this Act and another law are approved by the voters at the same election with one or more conflicting provisions and this Act receives fewer votes, the non-conflicting provisions of this Act shall go into effect. (G) Legal Defense. If any provision of this Act is challenged in court, it shall be defended by the Attorney General of Ohio. The People of Ohio, by enacting this Act, hereby declare that the committee of individuals responsible for the circulation of the petition proposing this Act (“the Proponents”) have a direct and personal stake in defending this Act from constitutional or other challenges. In the event of a challenge, any one or more of the Act's Proponents shall be entitled to assert their direct and personal stake by defending the Act's validity in any court of law, including on appeal. The Proponents shall be indemnified by the State of Ohio for their reasonable attorney’s fees and expenses incurred in defending the validity of the challenged Act. In the event that the Act or any of its provisions or parts are held by a court of law, after exhaustion of any appeals, to be unenforceable as being in conflict with other statutory or constitutional provisions, the Proponents shall be jointly and severally liable to pay a civil fine of $10,000 to the State of Ohio, but shall have no other personal liability to any person or entity.

Readability score

See also: Ballot measure readability scores, 2017

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 Ohio Ballot Board wrote the ballot language for this measure. The FKGL for the ballot title is grade level 11, and the FRE is 44. The word count for the ballot title is 139, and the estimated reading time is 37 seconds.

Support

Yes on Issue 2, also known as Ohio Taxpayers for Lower Drug Prices, led the campaign in support of the initiative. Supporters called the initiative the Drug Price Relief Act. As of April 21, 2024, the AIDS Healthcare Foundation was responsible for 99.99 percent of the campaign's funds.

Supporters

Officials

• U.S. Sen. Bernie Sanders (I-Vermont)
• Sen. Cecil Thomas (D-9)
• Rep. Bill Patmon (D-10)
• Rep. Teresa Fedor (D-45)
• Mayor John Cranley of Cincinnati
• Chris Seelbach, Cincinnati City Council member
• Yvette Simpson, Cincinnati City Council member
• Wendell Young, Cincinnati City Council member
• Kevin Kelley, Cleveland City Council member
• Phyllis Cleveland, Cleveland City Counci member
• Michael Stinziano, Columbus City Council member
• Melanie Bates, Cincinnati Schools Board of Education member
• Michael Cole, Columbus City Schools school board member

Former officials

• U.S. Rep. Dennis Kucinich (D-10)
• U.S. Sen. Max Cleland (D-Georgia), former Administrator of Veterans Affairs
• Sen. Nina Turner (D-25), president of Our Revolution
• Sen. Shirley Smith (D-21)
• Rep. Wayne Coates (D-32)

Parties

• Democrats of Cuyahoga County
• Seneca County Democratic Party
• Cleveland Stonewall Democrats
• Butler County Democratic Party

Organizations

• AIDS Healthcare Foundation
• AIDS Healthcare Foundation of Cleveland and Columbus
• Our Revolution
• Ohio Academy of Family Physicians
• National Nurses United
• NAACP – Cleveland Chapter
• Ohio Dental Association of Minority Dentists
• Northern Ohio Breast Cancer Coalition
• VoteVets.org

Individuals

• Michael Weinstein, president of the AIDS Healthcare Foundation
• Matt Borges, former chairman of the Ohio Republican Party
• Robert Ruff, chairman of the Myasthenia Gravis Foundation of America's Medical Scientific Advisory Board

Arguments

Michael Weinstein, President of the AIDS Healthcare Foundation

Michael Weinstein, President of AIDS Healthcare Foundation, stated:

“

While we’ve seen ample evidence that there is seemingly no limit to the corporate greed of pharmaceutical companies, we also know that Americans are tired of feeling afraid every time they go to the doctor or it’s time to get a prescription filled. Astronomical prescription drug prices hurt everyone—except the drug makers’ bottom lines. This has got to stop.

”

Tracy Jones, Executive Director of the AIDS Taskforce of Greater Cleveland and a proponent of the measure, said:

“

Americans continue to express their deep concerns about the exploding costs of health care and prescription drugs. For people with chronic conditions including HIV, hepatitis and cancer who depend on their medications to stay alive, the urgent need to control high drug costs is more pressing than just a campaign slogan or simple policy discussion. Each day, people are choosing between the basic necessities of life and paying for their medications. Change starts at home, and that’s why we’re hitting the streets across the state to raise awareness and support for the Ohio Drug Price Relief Act. The fact that we’ve collected almost twice as many signatures than we need for the legislature to take action at this point clearly shows Ohioans’ broad support for lowering prescription drug prices. Our elected state leaders either need to deal with this issue directly or allow Ohio voters to take a stand in November 2016 for controlling drug prices if the legislators can’t bring themselves to take action.

”

Don McTigue, attorney for the initiative’s sponsors, stated:

“

The other thing is, of course, it would benefit all taxpayers, because the state would be spending less. So there’s an indirect benefit to taxpayers. The state could spend less on prescription drugs, or the state could buy more prescription drugs. It would free up some substantial money that the state could use for other programs.

”

Ohio Taxpayers for Lower Drug Prices criticized the opposition campaign and contributors to the opposition campaign, stating:

“

The drug industry is one of the nation’s biggest and most powerful political money machines. In 2016 the industry made $27.5 million in campaign contributions to Senate and House candidates. In 2016, three dozen drug companies chipped in more than $110 million to the campaign to defeat Proposition 61, the California version of the drug relief act. Despite being outspent by more than 5 to 1, Prop. 61 lost by only a narrow margin. Expect the drug industry to spend big in the fight against the Ohio drug price measure. These guys will stop at nothing to protect their ability to gouge Ohio taxpayers and patients. In the California Prop. 61 campaign drug company executives hid behind their richly-funded campaign TV ads and refused to take up a challenge to publicly debate pro-Prop. 61 leaders. The drug industry can be expected to run its Ohio campaign like its California campaign: no news conferences, no transparency, just lots and lots of slick – and misleading – ads. The drug companies don’t have right on their side but they do have the money.

”

Opposition

No on Issue 2, also known as Ohioans Against the Deceptive Rx Ballot Issue, led the campaign in opposition to the initiative. As of April 21, 2024, Pharmaceutical Research and Manufacturers of America (PhRMA), along with a PhRMA-owned LLC, was responsible for 100 percent of the campaign's funds.

Opponents

Coalition

The opposition campaign listed the following organizations as coalition partners:

• American Academy of Pediatrics, Ohio Chapter
• American Congress of Obstetricians and Gynecologists, Ohio
• Academy of Medicine of Cincinnati
• The Academy of Medicine of Cleveland & Northern Ohio
• Butler County Medical Society
• Caracole, Inc.
• Equitas Health
• Greater Dayton Area Hospital Association
• Healing Hearts of Central Ohio
• Mended Hearts
• Mental Health America of Franklin County
• National Alliance on Mental Illness of Ohio
• National Community Pharmacists Association
• Ohio Affiliate of Prevent Blindness
• Ohio Association of County Behavioral Health Authorities
• Ohio Children’s Hospital Association
• The Ohio Council of Behavioral Health & Family Services Providers
• Ohio Foot and Ankle Medical Association
• Ohio Hematology Oncology Society
• Ohio Hospital Association
• Ohio Nurses Association
• Ohio Ophthalmological Society
• Ohio Osteopathic Association
• Ohio Pharmacists Association
• Ohio Psychiatric Physicians Association
• Ohio Sickle Cell and Health Association
• Ohio Society for Health System Pharmacists
• Ohio State Medical Association
• Prevention Action Alliance
• AMVETS Department of Ohio
• The American Legion, Department of Ohio
• Catholic War Veterans, Department of Ohio
• Concerned Veterans of America
• Department of Ohio Marine Corps League
• Iraq and Afghanistan Veterans of America
• Italian American War Veterans, Ohio Post 34
• Jewish War Veterans, Department of Ohio
• Korean War Veterans Association, Department of Ohio
• Military Officers Association of America, Ohio Council of Chapters
• Military Order of the Purple Heart, Department of Ohio
• Ohio National Guard Enlisted Association
• Ohio National Guard Association
• Ohio State Association of County Veterans Service Commissioners
• Ohio State Association of County Veterans Service Officers
• The Retired Enlisted Association
• VFW, Department of Ohio
• NAACP – Columbus Branch
• ACT Ohio – Ohio’s Affiliated Construction Trades
• Canton Regional Chamber of Commerce
• Cincinnati USA Regional Chamber
• Columbus Chamber of Commerce
• Darke County Chamber of Commerce
• Dayton Area Chamber of Commerce
• Employers Health Purchasing Corporation
• Greater Medina Chamber of Commerce
• Lima Allen County Chamber of Commerce
• Ohio Alliance for Civil Justice
• Ohio Chamber of Commerce
• Ohio Chemistry Technology Council
• The Ohio Council of Retail Merchants
• Ohio Farm Bureau Federation
• Ohio Grocers Association
• Ohio Manufacturers’ Association
• Ohio State Grange
• Pharmaceutical Research and Manufacturers of America (PhRMA)
• The Presidents’ Council – Business Chamber
• Toledo Area Small Business Association
• Toledo Regional Chamber of Commerce
• Westerville Chamber of Commerce
• Youngstown Warren Regional Chamber of Commerce
• BioOhio
• Biotechnology Innovation Organization
• Ohio Fire Chiefs’ Association
• The Interdenominational Ministerial Alliance of Columbus and Vicinity
• PERI, Public Employee Retirees, Inc.

Individuals

• John McCarthy, former state Medicaid director
• Barbara Edwards, former state Medicaid director
• Maureen Corcoran, former state Medicaid director
• Chris Goff, CEO and General Counsel for Employers Health
• Grover Norquist, president of Americans for Tax Reform

Organization

The following organizations opposed Issue 2, but were not listed as coalition members on the opposition campaign's website:

• Greater Cleveland Partnership

Parties

• Stonewall Democrats of Central Ohio

Arguments

Ohioans Against the Deceptive Rx Ballot Issue made the following argument against the initiative on the campaign's website:

“

HIGHER DRUG COSTS. REDUCED ACCESS TO MEDICINES. Experienced experts agree: the ballot proposal won't lower health care costs for Ohioans or save money for taxpayers. In fact, it could lead to increased costs for the majority of Ohioans, including seniors and veterans, while reducing patients’ access to needed medicines. MORE LAWSUITS. WASTED TAX DOLLARS. Experts say the measure would be nearly impossible to implement and will lead to more red tape and government bureaucracy. What’s more, the ballot issue’s sponsors cunningly slipped in an unprecedented provision giving them a blank check to intervene — at taxpayer expense — in any legal challenges that may be filed.

”

Ohioans Against the Deceptive Rx Ballot Issue also criticized the initiative's sponsor, the AIDS Healthcare Foundation, stating:

“

Issue 2 is being promoted by a billion-dollar California-based non-profit, the AIDS Healthcare Foundation (AHF), that gets nearly 80% of its revenue from selling prescription drugs. AHF’s controversial leader Michael Weinstein has been accused of using millions of tax-exempt dollars generated by his organization for political purposes unrelated to the mission of his foundation.

”

Who is promoting Ohio Issue 2?
October 18, 2017: Ohioans Against the Deceptive Rx Issue, a political action committee (PAC) opposed to the Ohio Issue 2 initiative, claims, "Issue 2 is being promoted by a billion-dollar California-based nonprofit, the AIDS Healthcare Foundation (AHF), that gets nearly 80% of its revenue from selling prescription drugs." Is this accurate? Read Ballotpedia's fact check »

Priscilla VanderVeer, a spokesperson for PhRMA, said:

“

The proposal lacks operational guidelines, disregards the state’s current drug purchasing and discount practices, and could negatively impact non-state pharmacy programs, including those that serve veterans. ... [The measure] would dramatically disrupt the system that serves those who depend on state programs for medicine, and the vague nature of the proposal will mean years of red tape and litigation, as public policy officials and impacted agencies struggle to figure out how it can be implemented.

”

Other arguments against the measure include:

• Jenny Camper, speaking on behalf of PhRMA, the Ohio Chamber of Commerce, and the Ohio Manufacturers' Association, said the proposal was "unworkable, offers zero implementation guidance and would create a long-term quagmire of bureaucratic red tape and litigation."

Campaign finance

Total campaign contributions:
Support:	$18,287,880.67
Opposition:	$59,125,540.98

See also: Campaign finance requirements for Ohio ballot measures

One ballot issue committee, Ohio Taxpayers for Lower Drug Prices, was registered in support of the initiative. The committee raised $18.29 million, 99.99 percent of which came from the AIDS Healthcare Foundation. The remaining amount came from donors who contributed $50 or less. The committee spent $16.71 million, with $1.87 million expended on the signature drive to get the initiative placed on the ballot.

One ballot issue committee, Ohioans Against the Deceptive Rx Ballot Issue, was registered in opposition to the initiative. The committee raised $59.95 million, breaking the previous record amount by a single ballot measure campaign ($47.1 million) set in 2009 by supporters of Amendment 3. The committee spent $58.61 million. Pharmaceutical Research and Manufacturers of America (PhRMA) and Ohioans Against the Deceptive Rx Ballot Issue LLC (a wholly-owned subsidiary of PhRMA) provided 100 percent of the campaign's funds.

The measure was similar to California Proposition 61, which spurred the most expensive ballot measure conflict of 2016. Opponents raised $109 million in their effort to defeat Proposition 61, while supporters raised $19 million.

As of 2017, Issue 2 was the most expensive ballot measure in Ohio state history. Prior to Issue 2, the most expensive ballot measure in Ohio was Amendment 3 of 2009, when $73 million was raised. Amendment 3 was designed to authorize a casino.

Support

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

Committees in support of Issue 2 Supporting committees Cash contributions In-kind services Cash expenditures Ohio Taxpayers for Lower Drug Prices $17,957,810.00 $330,070.67 $17,951,619.97 Total $17,957,810.00 $330,070.67 $17,951,619.97

Totals in support Total raised: $18,287,880.67 Total spent: $18,281,690.64

Donors

The following was the top donor who contributed to the Ohio Taxpayers for Lower Drug Prices:

Donor	Cash	In-kind	Total
AIDS Healthcare Foundation	$17,957,000.00	$330,070.67	$18,287,070.67

Opposition

The following were the contribution and expenditure totals for the committee in opposition to the initiative.

Committees in opposition to Issue 2 Opposing committees Cash contributions In-kind services Cash expenditures Ohioans Against the Deceptive Rx Ballot Issue $56,949,129.00 $2,176,411.98 $56,435,551.42 Total $56,949,129.00 $2,176,411.98 $56,435,551.42

Totals in opposition Total raised: $59,125,540.98 Total spent: $58,611,963.40

Donors

The following were donors who contributed to the Ohioans Against the Deceptive Rx Ballot Issue committee:

Donor	Cash	In-kind	Total
Ohioans Against the Deceptive Rx Ballot Issue LLC (a wholly-owned subsidiary of PhRMA)	$56,949,129.00	$0.00	$56,949,129.00
Pharmaceutical Research and Manufacturers of America (PhRMA)	$0.00	$2,176,411.98	$2,176,411.98

Reporting dates

Ohio ballot measure committees filed a total of four campaign finance reports in 2017. The filing dates for reports were as follows:

2017 campaign finance reporting dates
Date	Report	Period
1/31/2017	Annual Report for 2016	1/01/2016 - 12/31/2016
7/31/2017	Report #1	1/01/2017 - 6/30/2017
10/26/2017	Report #2	7/01/2017 - 10/18/2017
12/15/2017	Report #3	10/19/2017 - 12/08/2017
1/31/2018	Annual Report for 2017	1/1/2017 - 12/31/2017

Methodology

To read Ballotpedia's methodology for covering ballot measure campaign finance information, click here.

Media editorials

See also: 2017 ballot measure media endorsements

Support

• The Toledo Blade said: "Issue 2 is not a perfect or a complete solution, but it is a small, respectable first step toward more reasonable drug prices, self-government, and the public’s self-respect. [...] The Blade recommends a vote FOR Issue 2."

If you are aware of any other editorials in support of Issue 2, please email it to editor@ballotpedia.org.

Opposition

• The Canton Repository said: "You can rest assured, too, that Issue 2 would end up in court. Taxpayers would foot that bill, paying either the state attorney general or the “reasonable” attorney fees and other expenses of the petitioners. We cannot endorse such a blank-check likelihood."
• The Plain Dealer (Cleveland.com) said: "Rejecting this troubling, poorly drafted ballot issue doesn't mean that we support the drug industry's often arbitrary sky-high drug pricing. We categorically do not. Drug companies ought to be reined in. But passing a statute that is impractical, litigation-prone and that's likely to do little to address the problem of overpriced drugs isn't the answer. That's why Issue 2 is a problem, not a cure."
• The Columbus Dispatch said: "The Ohio Drug Price Relief Act would not do what its name suggests. It is based on wishful thinking and misinformation. It is strewn with health and financial landmines. It is bad public policy. And it won’t work." The newspaper published a second editorial on Issue 2, stating: "The highly confusing Ohio Drug Price Relief Act boils down to this: Ohioans would be stuck with an unworkable ballot-initiated law that, given its faulty premise, won’t produce the fantastical savings promised."
• The Herald Star, Parkersburg News and Sentinel, The Intelligencer, and Tribune Chronicle, which are owned by Ogden Newspapers, said: "Assume for a moment that pharmaceutical companies do grant additional discounts to government buyers. Surely no one believes those companies will not increase prices charged to private consumers to make up their losses on state contracts. Issue 2 could mean millions of Ohioans would pay more for drugs. ... Clearly, Issue 2 is bad medicine for Ohioans, who ought to say no to it Nov. 7."
• The Chronicle-Telegram said, "People are understandably angry about the high cost of drugs and want to send a message to Big Pharma. It's tempting, but ultimately Issue 2 would do more harm than good. There does need to be some sort of regulatory scheme to keep medication affordable, but Issue 2 isn't it. Voters should reject Issue 2."

Other opinions

• Akron Beacon Journal published four editorials on Issue 2. The editorial board did not make an explicit recommendation on the initiative in the articles.

August 26, 2017: "Yes, the drug companies are paying for the opposition, and true, they cut an unsympathetic profile. That doesn’t translate into looking past what is structurally unsound about Issue 2."

September 5, 2017: "Issue 2 reflects the right instinct. Drug prices are too high, many left to choose between medication and other necessities. Other countries better manage the cost of prescription drugs. The problems with Issue 2 come in the flawed structure and lack of detail, reflected in the puny explanation of the savings analysis."

September 11, 2017: "Suppose Issue 2 does pass, and implementation follows. Drug companies would seek to make up for any lost revenue. That would lead to a familiar element in health care — cost-shifting, [sic] Other Ohioans may see higher prices or less access to drugs. This collateral harm, as the four former directors explain, doesn’t appear to have a role in the analysis for proponents."

October 12, 2017: "There may be merit in Ohio voters sending drug companies a message. Then, there is the morning after. State lawmakers would face adding practical detail in trying to make the law work. No doubt, prolonged lawsuits would follow. To what end? The state budget office cites too many unknowns about how Issue 2 would address the problem."

Polls

See also: 2017 ballot measure polls

According to Matt Borges, a consultant for the Issue 2 support campaign, polling in late October 2017 showed 42 percent of respondents in favor of the measure and 46 percent opposed. Ballotpedia does not have access to the details of the poll and, thus, cannot include it in the table below.

Ohio Issue 2 (2017)
Poll	Support	Oppose	Undecided	Margin of error	Sample size
SurveyUSA 8/1/2017 - 8/6/2017	30.0%	15.0%	54.0%	+/-4.3	532
Note: The polls above may not reflect all polls that have been conducted in this race. Those displayed are a random sampling chosen by Ballotpedia staff. If you would like to nominate another poll for inclusion in the table, send an email to editor@ballotpedia.org.

Background

California Proposition 61

See also: California Proposition 61, Drug Price Standards (2016)

Californians voted on Proposition 61 on November 8, 2016. The measure was defeated. Proposition 61 was designed to require state agencies to pay the same prices that the U.S. Department of Veterans Affairs pays for prescription drugs. The measure would have only applied to the purchasing of drugs by state agencies and not to purchases made by individuals.

Issue 2 was similar to Proposition 61. Professor Rachel E. Sachs of the Washington University in St. Louis School of Law deemed the two measures nearly identical, and Alan Johnson of The Columbus Dispatch called them almost identical. The following table illustrates the similarities and differences, with highlighted differences in italics, between Ohio Issue 2 and California Proposition 61:

Ohio Issue 2 (2017) "The Ohio Drug Price Relief Act"	California Proposition 61 (2016) "The California Drug Price Relief Act"
• Adds a new section to Ohio Revised Code	• Adds a new section to California Welfare and Institutions Code
• Forbids state agencies from entering into purchasing agreements with drug manufacturers unless the net cost of the drug is the same or less than that paid by the VA.	• Forbids state agencies from entering into purchasing agreements with drug manufacturers unless the net cost of the drug is the same or less than that paid by the VA.
• Applies to all programs where the state is the ultimate payer for the drug, even if it did not purchase the drug directly.	• Applies to all programs where the state is the ultimate payer for the drug, even if it did not purchase the drug directly.
• No equivalent provision excluding Medicaid managed care.	• Excludes drugs purchased or procured under Medi-Cal (Medicaid) managed care.
• Ohio Governor and General Assembly may take any additional actions to promptly carry out the initiative's provisions.	• General Assembly may amend the initiative with a two-thirds vote of both chambers to further its purposes.
• Defended against lawsuits by the Ohio Attorney General. However, proponents have a "direct and personal stake in defending" the initiative and may defend it in any court. The state shall provide reasonable compensation to the proponents' attorneys for defending the measure.	• Defended against lawsuits by the California Attorney General. However, proponents have a "direct and personal stake in defending" the initiative and may defend it in any court. The state shall provide reasonable compensation to the proponents' attorneys for defending the measure. Proponents defending the measure would not be considered at-will employees, but could be removed from defense by the legislature when good cause exists to do so. Proponents would take the Oath of Office.
• If the measure is ruled unenforceable, proponents shall pay a civil fine of $10,000 to Ohio.	• If the measure is ruled unenforceable, proponents shall pay a civil fine of $10,000 to the General Fund of California.

The major difference between the two initiatives was that California Proposition 61 would have exempted from price regulation drugs purchased or procured under Medi-Cal (Medicaid) managed care programs. Ohio Issue 2 does not exempt from price regulation drugs purchased or procured under Ohio Medicaid managed care programs. Medicaid managed care programs are insurance companies or networks of healthcare providers that contract with Medicaid to provide care for Medicaid recipients. People who use Medicaid managed care programs must sign up for plans to receive services. In 2011, about 60 percent of California Medi-Cal recipients and 75 percent of Ohio Medicaid recipients were enrolled in managed care programs.

The AIDS Healthcare Foundation was a major donor to Californians for Lower Drug Prices, the campaign supporting Proposition 61. Michael Weinstein filed the petition for the initiative.

The support and opposition campaigns raised a combined total of $128.3 million.

Changes in drug prices

For 2008, Express Scripts Lab (ESL), a branch of the nation's largest prescription-drug benefits administrator Express Scripts, calculated a fixed market baskets for the top 80 percent of utilized prescription drugs. ESL calculated two fixed market baskets, one for brand-name prescription drugs (Brand Prescription Price Index) and one for generic prescription drugs (Generic Prescription Price Index), and set these at $100. ESL also set the Consumer Price Index at $100 for 2008. In 2009, ESL evaluated the value of each fixed market basket to determine whether the basket's value changed. This analysis was continued each year through 2016.

According to ESL's data, the Consumer Price Index increased 14.38 percent between January 1, 2008, and January 1, 2016. The Brand Prescription Price Index increased 207.86 percent. The Generic Prescription Price Index decreased 73.73 percent. Therefore, the data indicates that brand-name prescription drug prices increased and generic prescription drug prices decreased between 2008 and 2016. As of 2016, 85.4 percent of prescriptions for drugs were for generic drugs, according to ESL.

Reports and analyses

Ballotpedia identified three published analyses addressing Ohio Issue 2. Ohio Taxpayers for Lower Drug Prices, the campaign in support of Issue 2, hired Maxwell J. Mehlman, director of the Law-Medicine Center at Case Western Reserve University School of Law, to estimate the impact of the ballot measure. PhRMA, a group opposed to Issue 2, hired researchers associated with Vorys Health Care Advisors and Health Management Associates to estimate the impact of the initiative. The Ohio Office of Budget and Management published a fiscal analysis of Issue 2.

Maxwell J. Mehlman

Ohio Taxpayers for Lower Drug Prices, the campaign in support of Issue 2, hired Maxwell J. Mehlman, director of the Law-Medicine Center at Case Western Reserve University School of Law, to analyze Issue 2. Mehlman wrote, "Drug prices in the U.S. are unconscionably high. The only hope of controlling drug prices is public action like the act."

Using data from Patrick Murray of the MetroHealth Center for Health Care Research and Policy, Mehlman estimated that the state would save between $164 million and $536 million per year. He said:

“

Contrary to the drug industry, the government of Ohio can identify the vast majority of drugs that the VA purchases. It also can determine how much the VA pays for these drugs, and compare those prices with what state programs pay. The state then can limit what it pays as provided for by the act.

”

Vorys Health Care Advisors and Health Management Associates

The Pharmaceutical Research and Manufacturers of America (PhRMA), a group opposed to the initiative, hired researchers associated with Vorys Health Care Advisors (VHCA) and Health Management Associates (HMA) to estimate the impact of the initiative on Ohio. The VHCA and HMA researchers estimated the initiative would affect four million Ohioans.

VHCA and HMA noted that the initiative would likely fail to achieve its desired goal of reducing drug prices to levels the VA pays for the following reasons:

“

First, complete information regarding what drugs the VA purchases and the lowest price the VA pays is not generally available. Second, even if all necessary information could be obtained, the VA’s lowest price paid is not a reasonable net cost target for state drug programs. Third, it is not reasonable to assume that a large number of manufacturers would be willing to voluntarily negotiate the deeper discounts/rebates needed to achieve the benchmark net cost.

”

According to the report, requiring the state to negotiate drug prices down to levels secured by the VA may result in state agencies losing rebate arrangements and access to some drugs. If multiple states pass similar laws, then manufacturers may be hesitant to negotiate additional discounts with the VA.

Ohio Office of Budget and Management

The state Office of Budget and Management (OBM) published a fiscal analysis of Issue 2. The OBM's report concluded that "... theoretically, if all the issues identified in this analysis were worked through to successful implement Issue 2, it is likely there would be some state savings." However, the OBM also said that the office could not "calculate net state savings with an acceptable degree of accuracy" due to the following issues:

• The VA's final prices for drugs are often not known due to supplemental discounts the VA receives.
• Ohio purchases different pharmaceuticals than the VA due to differences in the demographics of healthcare recipients. The state of Ohio, through programs like Medicaid, serves a diverse population that includes women and children. The VA serves mostly men over age 45.
• The response of drug manufacturers to Issue 2 could impact savings. The report stated, "... even if the state were to initially benefit from some drug expenditure savings by receiving VA prices, drug manufacturers could and likely would seek to recover lost revenue."

The OBM said two state programs, Ohio Medicaid and the HIV Drug Assistance Program, would not likely experience savings under Issue 2 because drugs purchased by both programs "may already be as low or lower on average than what the VA pays." According to the OBM, the following state agencies and programs appear to pay more for drugs than the VA: "Ohio State University medical center, higher education institutions, state employee health benefits, workers’ compensation, institutional facilities, and the children with medical handicaps program..."

Reactions

Dennis Willard, spokesperson for Ohio Taxpayers for Lower Drug Prices, said the OBM's analysis showed that the state of Ohio would save money under Issue 2. He stated, "All along we have maintained that the big drug companies would not be spending $2-3 million a week to bombard the television airwaves with misleading and false ads if their bottom line was not on the line."

Dale Butland, Communications Director of Ohioans Against the Deceptive Rx Ballot Issue, said the analysis showed that Issue 2 is flawed. He stated, "Issue 2 is simplistic, unworkable and built on a flawed foundation. It therefore can't and won't achieve anything remotely close to the wild savings estimates touted by Issue 2 proponents. Further, Issue 2 could very well increase costs for a majority of Ohio consumers, while reducing access to needed medicines for some of our most vulnerable citizens."

Path to the ballot

See also: Laws governing the initiative process in Ohio

As an indirect initiated state statute, sponsors of the initiative needed to collect two installments of signatures that together equaled six percent of the votes cast for governor in the most recent election. The previous gubernatorial election was in 2014, and 3,055,913 citizens came out to vote. Therefore, each installment needed was 91,677, which totaled 183,354. Ohio also requires initiative sponsors to submit 1,000 signatures with the initial petition application. The overall total number of valid signatures that sponsors of the initiative needed to collect was 184,354.

The Ohio attorney general's office received supporters' petition with 1,000 signatures on July 22, 2015, and certified the petition on August 3, 2015. The Ohio Ballot Board approved the initiative for circulation on August 13, 2015. The committee to represent the petitioners included William Booth, Daniel Darland, Tracy Jones, and Latonya Thurman.

On December 22, 2015, proponents affiliated with AIDS Healthcare Foundation and Ohioans for Fair Drug Prices, which was later renamed Ohio Taxpayers for Lower Drug Prices, reported submitting 171,205 signatures for verification. The Ohio secretary of state's office certified the measure on February 4, 2016, and it was sent to the Ohio General Assembly. Legislators did not act on the measure, and supporters were cleared to begin collecting the next round of 91,677 signatures on June 5, 2016.

Supporters said that they could not collect the 91,677 signatures by the July deadline for the November 2016 ballot. Instead, Ohioans for Fair Drug Prices said that it would aim for the November 2017 ballot. On August 15, 2016, the Ohio Supreme Court, in Ohio Manufacturers' Association v. Ohioans for Drug Price Relief, invalidated 10,303 signatures among those submitted in December 2015, giving the campaign the option to resubmit its initiative to the Ohio General Assembly. On August 17, 2016, Ohioans for Drug Price Relief filed their own lawsuit in Jones v. Husted, asking the Supreme Court to recover signatures Secretary of State Husted tossed in December 2015. On September 9, the court ruled in supporters' favor, giving them enough December signatures to move forward. Petitioners submitted the second-round of signatures on August 31, 2016.

Secretary of State Jon Husted (R) verified 120,030 second-round signatures on September 30, 2016, and ordered the initiative to appear on the 2017 general election ballot.

Cost of signature collection:
Sponsors of the measure hired PCI Consultants, Inc. to collect signatures for the petition to qualify this measure for the ballot. A total of $1,867,206.70 was spent to collect the 184,354 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $10.13.

Timeline

The following is a timeline detailing the initiative's path to the ballot:

• July 22, 2015: Petitioners filed 1,000 signatures to receive certification of their initiative petition.
• August 13, 2015: The Ohio Ballot Board approved the initiative for signature gathering.
• December 22, 2015: Ohioans for Fair Drug Prices submitted 171,205 signatures for verification.
• December 30, 2015: Ohio Manufacturers' Association v. Ohioans for Drug Price Relief was filed in the Ohio Supreme Court.
• February 4, 2016: 96,936 signatures were deemed valid, and the measure was sent to the state Legislature for consideration.
• June 5, 2016: The state legislature did not act, requiring supporters to collect an additional 91,677 signatures to get the measure placed on the ballot.
• August 15, 2016: The Ohio Supreme Court invalidated 10,303 signatures from the December filing in Ohio Manufacturers' Association v. Ohioans for Drug Price Relief. As this lowered the signature count to 86,633 - about 5,044 below the number required in December - the campaign needed to collect signatures to send the measure to the state legislature again.
• August 17, 2016: Ohioans for Drug Price Relief filed a lawsuit in Jones v. Husted, asking the state Supreme Court to recover signatures Secretary of State Husted tossed in December 2015.
• August 31, 2016: A second round of signatures was submitted, with the campaign not knowing whether the signatures counted as the second round or first round due to the pending lawsuit.
• September 9, 2016: The court recovered 20,840 signatures that were deemed invalid in December 2015, meaning the valid signature count from the first round of submissions was 107,473 .
• September 30, 2016: A total of 120,030 second-round signatures were verified, and the measure was certified for the 2017 ballot.

Petition

The petition that supporters of Issue 2 used to collect signatures contained the following description of the initiative:

Ohio Drug Price Relief Act The Act would enact Section 194.01 of the Ohio Revised Code to require that notwithstanding any other provision of law and in so far as permissible under federal law, the State of Ohio shall not enter into any agreement for the purchase of prescription drugs or agree to pay, directly or indirectly, for prescription drugs, including where the state is the ultimate payer, unless the net cost is the same or less than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs. Among other provisions, the Act also: Sets forth the title of the Act as "The Ohio Drug Price Relief Act." Sets forth Findings and Declarations and Purposes and Intent of the Act. Sets forth factors in determining "net cost." Authorizes state departments, agencies and other state entities to adopt administrative rules to implement the provisions of the Act. Provide that the Act shall liberally construed to effectuate its purpose. Provide that if any provision of the Act is held to be invalid, the remaining provisions shall remain in effect. Provide that if the Act is challenged in court, it shall be defended by the Attorney General. Declare that the committee of individuals responsible for circulation of the petition ("the proponents") have a direct and personal stake in defending the Act and any one or more of them may do so in court if challenged. Provide that the proponents shall be indemnified by the state for their reasonable attorney's fees and expenses in defending against a legal challenge to the Act. Provide that the proponents shall be jointly and severally liable to pay a civil fine of $10,000 to the state if the Act or any of its provisions are held by a court to be unenforceable, but shall have no other personal liability. Provide that in the event that the Act and another law are adopted by the voters at the same election and contain conflicting provisions and the Act received less votes, the non-conflicting provisions of the Act shall take effect. Require the General Assembly to enact any additional laws and the Governor to take any additional actions required to promptly implement the Act.

Lawsuits

Lawsuits overview
First lawsuit
Issue: Signature validity; alleged violation of petition circulation laws by defendant.
Court: Ohio Supreme Court
Ruling: Ruled in favor of plaintiffs, disqualifying 10,303 signatures
Plaintiff(s): Ohio Manufacturers’ Association, Ohio Chamber of Commerce, Pharmaceutical Research and Manufacturers of America, Keith A. Lake, and Ryan R. Augsburger	Defendant(s): Ohioans for Drug Price Relief
Plaintiff argument: Proponents broke petition circulations laws to the point of signatures falling below the legal threshold of consideration.	Defendant argument: Signatures were valid.
Second lawsuit
Issue: Signature validity; alleged miscount of signatures by defendant.
Court: Ohio Supreme Court
Ruling: Ruled in favor of plaintiffs, recovering 20,840 signatures
Plaintiff(s): Tracy L. Jones, William S. Booth, Daniel L. Darland, and Latonya D. Thurman (Ohioans for Drug Price Relief)	Defendant(s): Secretary of State Jon Husted
Plaintiff arguments: Husted's office should have counted signatures on petitions containing other signatures crossed out.	Defendant arguments: The issue had been adjudicated by a court already, and there was an unreasonable delay in filing the case.

  Sources: Ohio Supreme Court and Ohio Supreme Court

On December 30, 2015, a law firm representing the Pharmaceutical Research and Manufacturers of America (PhRMA) sent a letter to the secretary of state's office that alleged there were several issues with the petitions Ohioans for Fair Drug Prices had submitted. Although county boards of elections across Ohio had certified the petitions, Secretary of State Jon Husted sent the petitions back for a second review, versus sending the measure to the Ohio General Assembly in the next step of the initiative process.

Ohioans for Fair Drug Prices, which later changed its name to Ohio Taxpayers for Lower Drug Prices, filed a lawsuit with the Ohio Supreme Court against Husted on January 6, 2016, claiming he was actively trying to keep the measure from reaching the ballot. AIDS Healthcare Foundation President and member of the campaign Michael Weinstein said he was concerned the review process would take too long and prevent the measure from being certified in time for the November ballot. The secretary of state's office said the second review was to ensure the integrity of the initiative process. A federal judge dismissed the lawsuit on April 19, 2016, because the supporters could not show sufficient harm and therefore lacked standing.

Initiative proponents filed a second challenge against Husted in federal court on January 14, 2016, and the case was assigned to U.S. District Judge Michael Watson. Don McTigue, a Columbus attorney hired to represent initiative advocates, said, "As a matter of law, Secretary Husted cannot simply decide to send the petitions back to the county boards to be rechecked and not transmit the proposed law on to the Assembly." Husted spokesman Josh Eck said the office had a responsibility to determine whether or not the challenge against Ohioans for Fair Drug Prices was credible, saying, "A couple of weeks' time is not too high a price to pay for fairness." On April 19, 2016, a federal judge dismissed the case, saying that the plaintiffs could not show sufficient harm.

On February 4, 2016, Husted certified the measure and sent it to lawmakers in the next step of the initiative process. He had sent all 119,000 signatures collected back to county boards of elections for a second review and more than 35,000 signatures were deemed invalid. "I believe the evidence confirms my suspicion that, at some high level of this campaign, the order was given to strike thousands of petition signatures," Husted wrote to lawmakers. However, petitioners still had 96,936 valid signatures and the measure moved on to the next step of the process.

Ohio Manufacturers' Association v. Ohioans for Drug Price Relief

On February 29, 2016, the Ohio Manufacturers' Association and the Ohio Chamber of Commerce joined PhRMA in a legal challenge, seeking to have signatures thrown out. Attorney Kurt Tunnell said:

“	There is clear evidence that proponents broke the law to the point of signatures falling below the legal threshold of consideration.	”
—Kurt Tunnell

On June 2, 2016, the Ohio Supreme Court voted six-to-one to refuse to accept motions to delay signature collection by Ohioans for Fair Drug Prices. The Supreme Court assigned retired appeals judge Patrick McGrath to review motions and conduct hearings on evidence.

On August 15, 2016, the Supreme Court, in a six-to-one decision, invalidated 10,303 of the campaign’s signatures from December 2015, leaving the initiative with 5,044 signatures short of initial certification. The 10,303 signatures were invalidated because 929 were collected by circulators who listed non-permanent residences as addresses where they could be reached and 9,374 were overcounts. Proponents had the option to collect additional signatures, restarting the process and sending the initiative back to the legislature again in 2017. Judge Paul Pfeifer was the lone dissenter in the decision. He wrote:

“	The fallout from today's decision will undoubtedly multiply the challenges to both state and local citizen petitions of all types as well as to the efforts of any citizen seeking to stand for election to public office. Any suggestion that our court's decision is protecting Ohio citizens from election fraud is a complete fiction. What we have is a government protecting itself from its people. Today, the walls got higher.	”
—Judge Paul Pfeifer

In response to the court's ruling, Ohioans for Fair Drug Prices filed Jones et al. v. Husted. Michael Weinstein stated:

“	Now, Monday’s Supreme Court ruling in the PhRMA case forces backers to gather an additional 5,044 signatures ... However, the ruling also appears to overturn Husted’s invalidation of more than 20,000 signatures previously thrown out by him. The committee is now suing to get further clarity from the court and restore those other signatures—which are more than enough to force Husted to advance this measure for consideration and possible action by the Ohio legislature as the next step in the process of ultimately bringing this drug pricing issue before Ohio voters in ballot measure form in November 2017.	”
—Michael Weinstein

Jones v. Husted

Individuals associated with Ohioans for Fair Drug Prices filed litigation against Secretary of State Husted on August 17, 2016, alleging that he unlawfully invalidated signatures earlier in the year. Just two days earlier, Ohioans for Fair Drug Prices lost 10,303 signatures in Ohio Manufacturers' Association v. Ohioans for Drug Price Relief. However, the court, in that case, determined that tossing petitions because they contain signatures crossed out by someone other than the circulator or signer was an improper action. Plaintiffs asked the Supreme Court to recover such petitions thrown out in December 2015 by the secretary of state and county boards of elections.

In a four-to-three decision, the Supreme Court handed Ohioans for Fair Drug Prices a victory on September 9, 2016. Secretary of State Jon Husted was ordered to count 20,840 signatures that were invalidated in December 2015. It was also determined that if enough second-round signatures were verified, then the initiative would appear on the November 7, 2017, ballot.

On September 30, 2016, Secretary of State Jon Husted validated 120,030 second-round signatures, about 28,000 more than were required. He said the initiative would appear on the next general election ballot, which was on November 7, 2017.

State profile

Demographic data for Ohio
	Ohio	U.S.
Total population:	11,605,090	316,515,021
Land area (sq mi):	40,861	3,531,905
Race and ethnicity**
White:	82.4%	73.6%
Black/African American:	12.2%	12.6%
Asian:	1.9%	5.1%
Native American:	0.2%	0.8%
Pacific Islander:	0%	0.2%
Two or more:	2.5%	3%
Hispanic/Latino:	3.4%	17.1%
Education
High school graduation rate:	89.1%	86.7%
College graduation rate:	26.1%	29.8%
Income
Median household income:	$49,429	$53,889
Persons below poverty level:	19.6%	11.3%
Source: U.S. Census Bureau, "American Community Survey" (5-year estimates 2010-2015) Click here for more information on the 2020 census and here for more on its impact on the redistricting process in Ohio. **Note: Percentages for race and ethnicity may add up to more than 100 percent because respondents may report more than one race and the Hispanic/Latino ethnicity may be selected in conjunction with any race. Read more about race and ethnicity in the census here.

Presidential voting pattern

See also: Presidential voting trends in Ohio

Ohio voted Republican in four out of the six presidential elections between 2000 and 2020.

Pivot Counties (2016)

Ballotpedia identified 206 counties that voted for Donald Trump (R) in 2016 after voting for Barack Obama (D) in 2008 and 2012. Collectively, Trump won these Pivot Counties by more than 580,000 votes. Of these 206 counties, nine are located in Ohio, accounting for 4.37 percent of the total pivot counties.

Pivot Counties (2020)

In 2020, Ballotpedia re-examined the 206 Pivot Counties to view their voting patterns following that year's presidential election. Ballotpedia defined those won by Trump won as Retained Pivot Counties and those won by Joe Biden (D) as Boomerang Pivot Counties. Nationwide, there were 181 Retained Pivot Counties and 25 Boomerang Pivot Counties. Ohio had eight Retained Pivot Counties and one Boomerang Pivot County, accounting for 4.42 and 4.00 percent of all Retained and Boomerang Pivot Counties, respectively.

More Ohio coverage on Ballotpedia

• Elections in Ohio
• United States congressional delegations from Ohio
• Public policy in Ohio
• Influencers in Ohio
• Ohio fact checks
• More...

Related measures

An initiative similar to California Proposition 61 and Ohio Issue 2 was filed in South Dakota targeting the 2018 ballot. This measure, however, was not backed by the AIDS Healthcare Foundation. Another similar initiative targeting the November 2018 ballot was filed in Washington, D.C., and is backed by the AIDS Healthcare Foundation.

Certified 2017 and 2018 healthcare-related measures are below.

2017

Healthcare measures on the ballot in 2017
State	Measures
Maine	Maine Question 2: Medicaid Expansion Initiative a

2018

Healthcare measures on the ballot in 2018
State	Measures
Nevada	Nevada Question 4: Medical Equipment Sales Tax Exemption Amendment a
Oregon	Oregon Measure 101: Healthcare Insurance Premiums Tax for Medicaid Referendum a
Idaho	Idaho Proposition 2: Medicaid Expansion Initiative
Massachusetts	Massachusetts Question 1, Nurse-Patient Assignment Limits Initiative d
Utah	Utah Proposition 3: Medicaid Expansion Initiative
Nebraska	Nebraska Initiative 427, Medicaid Expansion Initiative a
California	California Proposition 4: Children's Hospital Bonds Initiative a

See also

Suggest a link

• 2017 ballot measures
• Ohio 2017 ballot measures
• Laws governing the initiative process in Ohio
• Healthcare on the ballot
• Healthcare policy in Ohio

External links

Information

• Initiative Petition
• Ohio 2017 Ballot Board Issues Report

Support

• Yes on Issue 2 (website)
• Yes on Issue 2 (Facebook)
• Yes on Issue 2 (Twitter)

Opposition

• No on Issue 2 (website)
• No on Issue 2 (Facebook)
• No on Issue 2 (Twitter)

Recent news

The link below is to the most recent stories in a Google news search for the terms Ohio Issue 2 Drug Price Initiative 2017. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

Ohio Issue 2, Drug Price Standards Initiative (2017) - Google News