3 more states approve expansion of Medicaid

WASHINGTON — Despite the uncertainty and partisan gridlock that Tuesday’s election results ensure, one policy change seems guaranteed: hundreds of thousands more poor Americans in red states will qualify for free health coverage through Medicaid.

Voters in Idaho, Nebraska and Utah, all states that President Donald Trump won easily in 2016, approved ballot initiatives to expand the government insurance program under the Affordable Care Act. Democratic victories in governors’ races also improved the chances of Medicaid expansion in Kansas and Wisconsin and all but ensured it in Maine. As a result, Medicaid could see its biggest enrollment bump since the health law began allowing expansion in 2014.

For all the campaign warfare over the health law’s effect on insurance premiums and protections for people with pre-existing conditions, Medicaid has remained quite popular. In a Kaiser poll last month, 56 percent of people across the 17 states that had not yet expanded Medicaid said they favored doing so. And the share of people saying Medicaid was “very important” to them grew to nearly half during efforts to repeal the health law last year, Kaiser found.

“Medicaid per se is much more popular than the Affordable Care Act,” said Robert Blendon, a health-policy expert at Harvard. “And the people organizing these referendums on Medicaid expansion aren’t making them about the ACA. They’re taking a program that’s been in the state for years and adding to it, saying, ‘All these other people need coverage and we can get outside money for it.”’

The three states that approved expansion Tuesday will join Virginia, which this spring approved Medicaid expansion, and Maine, where voters approved an expansion last year that has been blocked by the outgoing Republican governor, Paul LePage. In all, nearly 800,000 people could be newly eligible for the program across the five states.

The number of states that have expanded Medicaid coverage to most of their poor adult population will increase to 37, including Ohio and the District of Columbia. Enrollment in the program has already grown by at least 15.6 million, or 28 percent, since 2013, the year before the health law’s main provisions took effect. That eclipses the 11.7 million people who have private health insurance through the law’s marketplaces.