Obamacare keeps making gains in the Trump era

WASHINGTON — President Donald Trump is still trying to overturn Obamacare, but his predecessor’s health care law keeps gaining ground in places where it was once unwelcome.

Missouri voters this week approved Medicaid expansion by a 53% to 47% margin, making the conservative state the seventh to do so under Trump. The Republican president carried Missouri in 2016, but the Medicaid vote comes as more people have been losing workplace health insurance amid the coronavirus pandemic.

That leaves only a dozen states opposed to using the federal-state health program for low-income people as a vehicle for covering more adults, mainly people in jobs that don’t provide health care. Medicaid expansion is a central feature of former President Barack Obama’s Affordable Care Act, covering about 12 million people, while nearly 10 million others get subsidized private insurance.

If present trends continue, it’s only a matter of time until all states expand Medicaid, acknowledged Brian Blase, a former health care adviser in the Trump White House, who opposes the expansion.

“(Medicaid expansion) is attractive to states because it’s almost all federal spending and the insurance companies and hospitals get lots of dollars when a state expands Medicaid,” he said.

The federal government pays 90% of the cost of covering people through the expansion, a much higher matching share than for low-income disabled and elderly people traditionally covered by Medicaid. Blase argues that’s an incentive to waste federal dollars.

The six states where voters have approved Medicaid expansion in the Trump years are Idaho, Maine, Missouri, Nebraska, Oklahoma and Utah. In Virginia, the legislature passed a Medicaid expansion after Democrats made political gains.