AROUND THE NATION (CNN) -- President Barack Obama's second term is on the line in Tuesday's election, but so is a key component of his signature health care reform law.
Four states are voting on whether to allow residents and businesses to avoid Obamacare's requirement that they purchase health insurance for themselves or their employees.
The ballot initiatives in Alabama, Florida and Wyoming would amend state constitutions. Montana's initiative prohibits federal and state government from requiring people to purchase health insurance through imposing a penalty, tax, fee or fine on those who do not do so.
"These laws may promise more than they can deliver," said Jonathan Turley, a law professor at George Washington University Law School. "What the laws certainly do is to give state officials more of a basis to go to court and challenge the national health care law."
In response to health care reform, 47 state legislatures proposed measures to limit, alter or oppose selected state or federal actions, according to the National Conference of State Legislatures.
Twenty states have challenged broad health care reform in anticipation of or in response to the Affordable Care Act. Health care reform was signed into law in 2010.
In addition to measures on health care reform, voters will also weigh same-sex marriage, abortion and capital punishment. Voters will decide on almost 180 ballot measures in 38 states. That's up from 159 in 2010, but down from 204 in 2008.
Requirements and the process by which initiatives make it to the ballot differ from state to state. In many instances, ballot initiatives were introduced in states like California in the form of propositions to circumvent the legislative process, giving citizens direct access to lawmaking.
But across the country Tuesday, many ballot initiatives and their corresponding voter turnout efforts are supported by wealthy individuals or special interest groups in addition to private citizens.
In Florida, where voters will decide on a constitutional amendment banning public funds for abortions, groups have formed using names like "Nix Six" or "Vote no on 6" or websites carrying names like www.sayyesto6.com, referring to the the initiative's ballot name: Amendment 6.
The "Say Yes to 6" website and effort are funded by the group Protect Florida Taxpayers and Parental Rights. The group is funded largely by a collection of Catholic archdioceses across Florida including Miami, St. Petersburg, Palm Beach and St. Augustine, which have given more than $175,000.
Planned Parenthood also entered the mix, spending $3.2 million on ads to defeat the measure in Florida during the week heading into the election.
In California, the story is similar. Billionaire Nicholas Pritzker, chairman of the board and chief executive of the Hyatt Development Corporation, donated $500,000 in support of Proposition 34, which would ban capital punishment in the state. He was joined by several other wealthy donors including Netflix CEO Reed Hastings, who donated $250,000.
Smaller donations supporting and opposing Proposition 34 and Amendment 6 also came from private citizens.