Meanwhile, Alaskans rejected a move that would have fully legalized marijuana for adults and would have given the state the right to tax and regulate the drug.
Sixty-two percent of Montana voters backed a ballot initiative legalizing medical marijuana use by patients with cancer, glaucoma, multiple sclerosis, and AIDS under the supervision of a doctor. The new law lets patients grow up to six plants for personal medical marijuana use and allows them to possess up to 1 ounce of cannabis.
Paul Befumo, who headed the ballot initiative effort, says in an interview that voters and lawmakers in the mostly-Republican state responded to his group's decriminalization push.
"They kind of heard the message that it's not a good idea to put sick people in jail for using medical marijuana when doctors recommend it," says the investment advisor from Missoula, Mont.
The initiative campaign was bankrolled by the Marijuana Policy Project, a national pro-legalization group that has set itself at sharp odds with federal officials over drug policy. The group was also involved in the Alaskan legalization initiative, which failed 58% to 41%.
"When people realize what's at stake, they stand up against legalization," says Jennifer DeValance, a spokeswoman for the White House Office of National Drug Policy. As a result of two court cases, Alaskans already have the right to possess up to 4 ounces of marijuana in their homes, making it the most permissive state in the country.
In reaction to the Montana vote, DeValance warned that federal officials could choose to crack down on marijuana users that violate federal law. Drug officials have prosecuted marijuana growers in California and Oregon who were operating legally under state laws.
Medical marijuana initiatives also passed in Ann Arbor, Mich., and in Columbia, Mo., though an effort to expand possession limits and make cannabis available through state-controlled dispensaries failed in Oregon.
Big Issues in California
Another controversial health issue -- embryonic stem cell research -- reached ballots in California on Election Day, as 59% of voters there approved a move that forces the state to issue bonds funding $3 billion in stem cell studies.
The initiative was widely seen as a reaction to a 2001 decision in which President George Bush limited federal funding for embryonic stem cell research.
Californians also approved a ballot question that raises income taxes on residents making more than $1 million per year to fund an expansion of state-run mental health services. The 1% tax hike is expected to raise $1.8 billion for the services between now and 2007, according to an analysis provided by the California Secretary of State's office.
Meanwhile, California voters narrowly rejected a move to force medium and large employers to provide health care coverage for workers. The initiative called for businesses employing over 50 workers to either fund 80% of employee's health coverage or pay a fee to the state to provide insurance starting in 2007.
Six million of California's 35 million residents lack health insurance.
California passed a law in 2003 laying out the mandates. Voters were required to pass Tuesday's question, called Proposition 72, in order for it to take effect. Instead, they rejected it 50.9% to 49.1% after strong opposition from the restaurant and retail industries.
The initiative, widely known as an employer mandate, is similar to the ill-fated proposal forwarded by then-first lady Hillary Rodham Clinton in 1993. Anthony Wright, head of Health Access California, a group backing Tuesday's proposal, tells WebMD that despite the loss, support has grown since the early 1990s.
He predicted that advocates would pursue the insurance mandate in future elections. "With costs increasing and the number of uninsured increasing, there's a logic and a need for health reform or the system will unravel," he says.