On November 5, 1996, the voters of Arizona overwhelmingly approved Proposition 203—the Healthy Arizona Initiative. Largely unnoticed amid publicity surrounding other propositions in Arizona and elsewhere (such as the legalization of certain drugs in Arizona and California), the Healthy Arizona Initiative stands out for what it will do to improve health care access. More important, it serves as testimony to what concerned citizens can do to establish sound health care policy when policymakers refuse to do so. Given lack of support by the political leadership of Arizona, the Healthy Arizona Initiative is a tribute to citizen action.
There are 3 methods that citizens can use to affect policy decisions outside the current representational framework—the initiative, the referendum, and the recall. Although a form of the referendum has existed since the birth of the nation as a method of constitutional ratification, the current forms of citizen-led policymaking evolved from the Populist
Nichols AW. Arizona Overwhelmingly Adopts Health Care Initiative. JAMA. 1997;277(20):1645-1648. doi:10.1001/jama.1997.03540440079038