HEALTH EQUITY, FEDERALISM, AND CANNABIS POLICY

Cannabis policy is a story of complexity and dynamism laced with tension and inequity. Policy makers' views are rapidly changing, reflected by many bills sitting before Congress. This Essay considers three of the major bills that have a more comprehensive approach to cannabis. These bills also take different approaches to the flipped federalism that could occur if the federal government were to suddenly decriminalize cannabis. The Essay next considers the state law landscape and compares it to Medicaid expansion under the Affordable Care Act, drawing a comparison to learn health equity lessons from recent health reform efforts. Federal legislation is needed and should at least reschedule marijuana under the Controlled Substances Act. But it should also create a legalization baseline that would improve the underlying determinants of health, which have been deeply affected by the fifty-year war on drugs. Additionally, Congress should consider how to make states into policy-making partners to more quickly entrench such a substantial policy shift. While states have been leading in cannabis policy making through the last decade, federal responsibility for major aspects of the legal landscape suggests that a federal response should take the lead and invite states to partner. Otherwise, the predictable variability of state law will continue to harm the health of already vulnerable populations.