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Direct Democracy in California – The Ballot Initiative Process

Initiatives are state or local legislative measures placed on the ballot by a group of citizens by means of a petition signed by a specified percentage of voters and enacted by a majority of the voters. The initiative process has been called California’s fourth branch of government, a frank recognition of the expanding role it plays in setting the state’s policy agenda.

Historically, the initiative process in California first arose out of the advocacy efforts of a then newly-formed Progressive political party with the support of the labor movement. It was a means to circumvent a state government in which the Southern Pacific Railroad and special interests were perceived as having too much power. By 1907, Los Angeles, Pasadena, San Diego, San Bernardino, Fresno, Sacramento, and Vallejo had all adopted city initiative and referendum ordinances. In 1911, voters followed the lead of Progressive Governor Hiram Johnson, and California became the tenth state to enact the initiative, referendum, and recall processes.

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Over the last 100 years, California has become one the heaviest users of the initiative process. With a state as large, populous, and geographically diverse as California, it is not a surprising occurrence.

Case in point: the upcoming midterm general election taking place this November.  

At last count, the Secretary of State’s website lists nearly 50 ballot initiatives moving through the qualifying process. Of that total, 33 are cleared for circulation, eight are pending with the Attorney General’s office, three have become fully eligible for the November general election, one is qualified for the ballot, and five others have been withdrawn or failed to qualify. Another eight to 12 additional initiatives will likely become fully eligible to appear on the November ballot.

Of the three initiatives that are already fully eligible, there is one of specific interest and concern to CAP and all California physicians. The initiative is entitled, “Adjust Limitations in Medical Negligence.” It is an initiative spearheaded by an out-of-state plaintiffs’ attorney and aims to drastically weaken the protections afforded to physicians by the Medical Injury Compensation Reform Act, better known as MICRA. This initiative will once again see CAP engaged in an all-out effort to secure those protections imparted to physicians by this long-standing law. And California voters will once again play a deciding role in this practice of direct democracy when they vote on this initiative in November.

Eligible Statewide Initiative Measures:   


Gabriela Villanueva is CAP’s Government and External Affairs Analyst. Questions or comments related to this article should be directed to