Issue 3: The Health Care Freedom Amendment

On Nov. 8, 2011 Ohio voters overwelmingly supported Ohio Issue 3 by a margin of about 67 percent to 33 percent. Because the constitutional amendment could have significant future implications on health policy in Ohio, HPIO plans to keep this resource page active for future reference.

The Health Policy Institute of Ohio (HPIO) is a nonprofit organization that serves as Ohio’s nonpartisan, independent source for health care research, analysis, education and dialogue. HPIO informs policymakers, state agencies and other health care stakeholders on key health care issues for the purpose of advancing informed health policy decisions in Ohio. Since voters are policymakers in the case of a ballot initiative, HPIO is providing a forum to educate voters by making diverse viewpoints on Issue 3 easily accessible. Consequently, the links to analyses and references contained herein are for educational purposes only and views expressed herein do not necessarily reflect the views of HPIO including HPIO staff, board members and funders.


On November 8, 2011, Ohioans will vote on Issue 3 – a ballot initiative creating a state constitutional amendment that proponents say will preserve individual health care freedom.

Click here for full text of the amendment

Ohio’s Constitution provides the foundation for all laws within the state.  Any amendment or change to the Ohio Constitution represents a significant policy change which has the potential to impact other policy issues and laws within the state. If passed, Issue 3 will amend the Ohio Constitution to include the following language:

“In Ohio, no law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in a health care system. In Ohio, no law or rule shall prohibit the purchase or sale of health care or health insurance. In Ohio, no law or rule shall impose a penalty or fine for the sale or purchase of health care or health insurance.”

Notably, the ballot language stipulates that the proposed constitutional amendment does not apply to

  • Rules in effect as of March 19, 2010, which is prior to the Patient Protection and Affordable Care Act of 2010 (PPACA)
  • Services a health care provider or hospital is required to perform or provide
  • Terms and conditions of government employment
  • Laws calculated to deter fraud or punish wrongdoing in the health care industry.

Much of the discussion around Issue 3 has centered on exempting Ohio from the “individual mandate” provision of the PPACA. This part of federal law, which will go into effect in 2014, requires Americans to have minimum coverage health care insurance or face monetary penalties. Notably, official arguments for and against Issue 3 published on the Ohio Ballot Board website do not specifically mention the PPACA, federal law, or the individual mandate.

Amending the Ohio constitution

A proposed amendment to the Ohio constitution can be initiated through three different processes: a constitutional convention, a joint resolution of the General Assembly or through a citizen-initiated petition. In all three processes, a constitutional amendment can only be adopted through a vote of the people.

Issue 3 is a citizen-initiated petition – which means that the constitutional amendment was proposed by Ohio citizens and will be submitted directly to the Ohio electorate without any action from the General Assembly.

The process for proposing a constitutional amendment through a citizen-initiated petition requires that petitioners submit an initial written petition to the Attorney General, signed by 1,000 qualified Ohio electors. The petition is forwarded to the Ohio Ballot Board for approval and is then filed with the Secretary of State.

Ultimately, petitioners for the constitutional amendment must collect a total number of signatures equal to at least ten percent (10%) of the total vote cast for the office of governor during the last gubernatorial election. Signatures are validated, arguments in favor of and against the amendment are filed and prepared, and the amendment is placed on the electorate ballot. If passed, the constitutional amendment takes effect 30 days after the election.

Perspectives on Issue 3

To provide an understanding of the potential implications of Issue 3, the Health Policy Institute of Ohio (HPIO) has asked Maurice Thompson of the 1851 Center for Constitutional Law and Janetta King of Innovation Ohio to write analyses on the potential impact of Issue 3 on Ohio if passed. Maurice Thompson is the author of Issue 3 ballot language and the Executive Director of the 1851 Center for Constitutional Law, a legal center dedicated to protecting the constitutional rights of Ohioans. Janetta King is the President of Innovation Ohio, a think tank based in Columbus that recently released a report highlighting the potential unintended consequences of Issue 3.

Passage of Issue 3 will protect liberty, restrain health care costs, and preserve health care choice and privacy by Maurice Thompson of the 1851 Center for Constitutional Law (pdf, 2 pages)

Issue 3: Sloppy, costly and wildly off-target by Janetta King of Innovation Ohio (pdf, 2 pages)

More information

Note: HPIO is attempting to maintain as complete a list of information on Issue 3 as possible. If you find a news article or other resource that is not included and that you think would be useful to Ohio voters as they make their decision on this issue, please submit it to HPIO Communications Manager Nick Wiselogel.

Neutral information

Supporters of Issue 3

Opponents of Issue 3

Newspaper endorsements

Media coverage