Med­ic­aid ex­pan­sion scores elec­tion wins, losses across the coun­try

Modern Healthcare - - News - By Har­ris Meyer

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.

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