A choice between reality and rhetoric
Voters in Idaho, Nebraska and Utah have the chance to force Republicans’ hands on Medicaid expansion.
IF THE politics of health care over the past two years has proved anything, it is that Americans generally want the government to ensure that everyone has access to decent coverage, particularly the most vulnerable. The midterm elections Tuesday will test how deep into GOP territory that attitude extends.
Voters in Idaho, Nebraska and Utah — three of the nation’s most Republican states — will decide whether to expand Medicaid within their borders. The federal-state partnership covers low-income Americans, and Obamacare expanded the number of people eligible for the program. Or it tried, anyway. The Supreme Court in 2012 made expansion optional for states, and a surprising number of red-state politicians refused to boost their Medicaid rolls, leaving millions of Americans with no reasonable health insurance option, even with the rest of Obamacare in place. There was never a good reason to refuse: the federal government picks up nearly all of the tab in expansion states, and the relatively small amount states must spend is offset by big savings on other health-care expenses for which states would have otherwise been responsible.
Opposition to expansion turned out to be unpopular as well as irrational, perhaps because the case for refusing was so bad and the costs to those affected so steep. Slowly but surely, GOP-led states have acceded to reality. Even Vice President Pence, when he was governor of Indiana, expanded Medicaid in his state. After a crushing slap from voters last year, Virginia Republicans finally ended their resistance to expansion. Nevertheless, rote GOP opposition to Obamacare has led 17 other states to continue holding out.
So organizers in three states decided to adopt a strategy that worked in Maine, whose reactionary Republican governor, Paul LePage, staunchly opposed expansion: asking voters directly. State-level ballot-initiative systems are double-edged swords, at best, and often result in poorly-vetted policy that hamstrings legislatures. But this is a case in which bypassing obstructionist state leaders makes sense.
According to the Kaiser Family Foundation, some 22,000 people in Idaho, 16,000 in Nebraska and 46,000 in Utah currently fall into the “coverage gap” — that is, they make too much to qualify for non-expansion Medicaid, but too little to qualify for Obamacare insurance subsidies. If voters in these three states decide Tuesday to expand their Medicaid programs, these people will finally have a health-care option that doesn’t involve going into debt or relying on emergency rooms for care that should have been addressed elsewhere.
It is rare that voters have an opportunity to so directly and immediately help tens of thousands of people. If the Idaho, Nebraska and Utah initiatives succeed, it will be a victory for reality over rhetoric.