Medicaid expansion scores election wins, losses across the country
FROM THE ROCKY MOUNTAINS to the Great Plains to New England, Medicaid expansion got a big boost last week.
Voters in Idaho, Nebraska and Utah approved ballot initiatives to extend Medicaid coverage under the Affordable Care Act to adults with incomes under 138% of the federal poverty level. Republican governors and lawmakers in those states had repeatedly refused to pass it.
Montana voters, though, rejected a ballot initiative to renew that state’s Medicaid expansion and fund it by sharply increasing the cigarette tax.
Democratic gubernatorial candidates who campaigned on expansion won in Kansas, Maine and Wisconsin, all states where Republican governors have rejected it. Those victories make expansion more likely.
On the other hand, Republican Ron DeSantis, who opposes expansion, was leading in the Florida governor’s race, with a recount likely, while neighboring Georgia was too close to call at press time and could be headed for a runoff election with Republican Brian Kemp holding the lead. Democratic candidates in both states made Medicaid expansion central to their campaigns.
In Michigan, a state that already expanded Medicaid, Democratic gubernatorial candidate Gretchen Whitmer prevailed against a GOP opponent who favored work requirements. She will now have to persuade GOP lawmakers not to move forward with those eligibility limits, which likely would reduce enrollment. But in Ohio, former U.S. senator and current Attorney General Mike DeWine, who supported work requirements for the state’s expansion program, beat a Democrat who opposed a work mandate.
In Alaska, the fate of that state’s expansion is uncertain following the gubernatorial victory of Republican Mike Dunleavy, who has criticized the program’s costs.
Overall, the outcome of Medicaid ballot initiatives and some of the governors’ races pleased healthcare providers and patient advocacy groups, who predicted greater access to needed healthcare services and a significant decline in uncompensated care.
Advocates view the election successes as a springboard to expand- ing Medicaid in nearly all 50 states and providing coverage to millions more Americans. Up to now, the single-biggest factor in winning expansion in resistant states like Louisiana and Virginia has been the election of a governor who supports it. Polls consistently show majority public support for expansion, even in the most conservative states.
Beyond that, Affordable Care Act supporters were ecstatic that Democratic control of the U.S. House of Representatives virtually guarantees there will be no legislative rollback of Medicaid or ACA coverage for at least the next two years. That could let Democrats shift from playing defense to pushing new initiatives on coverage expan-
sion, consumer protections and curbing prescription drug costs.
“Tonight’s election results are a resounding victory for everyone in our nation who cares about access to high quality, affordable health care,” the pro-ACA group Families USA said in a written statement.
Still, the ACA’s coverage gains and consumer protections remain threat- ened by a federal lawsuit in Texas filed by Republican attorneys general in which the judge may soon issue a ruling.
Medicaid expansion opponents, led by Americans for Prosperity, a libertarian, anti-tax group funded by the billionaire Koch brothers, argue that Democrats are hurting their states by pushing for expansion, which they say neither the states nor the federal government can afford.
The Medicaid ballot initiatives would expand coverage to an estimated 60,000 people in Idaho, 87,000 in Nebraska, and 62,000 in Utah. Top GOP elected officials in those states who mostly opposed the initiatives have said they would respect the will of the voters, though newly re-elected Nebraska Gov. Pete Ricketts has been tight-lipped about his intentions.
“I have talked to a number of my colleagues, and I think we will implement it and fund it properly,” said Nebraska Republican state Sen. John McCollister, an expansion supporter. “That will improve the financial health of our rural hospitals big time.”
In Montana, Big Tobacco kicked in an estimated $17 million to defeat a ballot initiative that would have renewed that state’s Medicaid expansion covering 90,000 low-income adults and funded it with a $2 per pack tax on cigarettes and a new tax on vaping products.
If it had passed, those Montanans would have been able to keep their coverage as is. Now it will be up to the Republican-controlled Legislature to decide the program’s fate when it expires in June. ●
Maine Gov.-elect Janet Mills, a Democrat, celebrates her victory with supporters on election night.