Three Deep Red States Vote to Expand Medicaid

 

Citizen power propelled the most important expansion of Medicaid in heavily Republican states since the first years of the Affordable Care Act, with many thousands of poor and vulnerable residents standing to realize health coverage as a result of Tuesday’s elections.

Voters in Idaho, Nebraska, and Utah approved ballot initiatives to incorporate in their Medicaid programs adults with incomes of up to 138 percent of the federal poverty level.

The results accomplish a broadening of the safety-net insurance that the states’ legislatures had balked at for years.

In addition, Maine voters elected Democrat Janet Mills as governor, clearing the trail for a Medicaid expansion that voters approved by referendum a year ago.

The outgoing GOP governor, Paul LePage, has been a fanatical foe of the expansion and had blocked it for a year, resulting in a court battle.

Mills has said she is going to expand the program on her first day in office.

On Wednesday, Montana officials were still tallying the results of the nation’s fourth Medicaid ballot initiative, which appeared as if it'd narrowly fail.

The state expanded Medicaid two years ago temporarily, thanks to the top of next summer.

The initiative would make the expansion permanent and add a cigarette tax of $2 per pack to buy the state’s share.

After Mainers put to voters in 2017 the question of the right scope of Medicaid, the grass-roots tactic spread quickly to other red states during which health-care-minded residents and activists, supported by significant outside funding on each side, gathered signatures to force the difficulty onto the ballot in an attempt to bypass years of resistance by conservative legislatures.

With all three expansion initiatives passing Tuesday, during a year during which health care loomed large as an election issue, longtime proponents of the ACA, which allowed the expansion, were elated Wednesday.

“This election proves that politicians who fought to repeal the Affordable Care Act got it wrong,” said Jonathan Schleifer, executive of the Fairness Project, a three-year-old Washington-based nonprofit that was the most important funder, spending quite $6 million on such activities as polling, signature gathering and advertising.

“Expanding access to health care isn’t a blue-state value or a red-state value; it’s an American value.”

Schleifer and Topher Spiro, vice chairman of health policy at the middle for American Progress said on a call that they decide to search for grass-roots partners in other non-expansion states that allow ballot initiatives, possibly Florida, Oklahoma, Missouri, and Mississippi.

Idaho’s Proposition 2 won particularly strong support, with 62 percent of the vote.

That initiative predicted to increase Medicaid to 62,000 Idahoans, drew a surprise endorsement last week from the state’s outgoing governor, C.L. “Butch” Otter (R), who said that reducing the number of uninsured Idahoans would have a ripple effect of stabilizing struggling rural hospitals and public health clinics.

Nebraska’s Initiative 427, estimated to form 87,000 poor residents eligible for Medicaid, passed with 53 percent of the vote.

For six years, the state legislature had rejected expansion bills.

In Utah, Proposition 3 passed with 54 percent of the vote and is predicted to enable 150,000 residents to qualify for Medicaid.

Utah Gov. Gary R. Herbert (R) signed into law in 2016 a bill that allowed a minor expansion focused on a couple of thousand people that are homeless or need treatment for addictions.

This year, he signed into law a partial expansion — to form eligible people with incomes of up to the poverty level — albeit federal officials haven't allowed such halfway steps.

The ballot initiative will overtake that partial expansion.

The effects of Tuesday’s votes will lower from 18 to 14 the number of states that haven't expanded their Medicaid programs to low-income people with slightly higher incomes.

The outstanding states, primarily within the South and Midwest, contain an estimated 2.2 million residents who would be eligible to hitch Medicaid in an expansion, consistent with a recent analysis by the Kaiser Family Foundation.

The checkerboard of states that have broadened Medicaid is that the effect of a wrinkle that the Democratic authors of the ACA never anticipated once they pushed the two,000-page statute through Congress in 2010.

At the outset, the law for the primary time created a consistent federal standard for who can join Medicaid, instead of leaving that call largely to states.

It said that adults without minor children could enroll nationwide, and it set the 138 percent income threshold — $16,753 for a private and $34,638 for a household of 4.

The original idea was that, when the expansion began in 2014, Medicaid would account for about half an outsized insurance increase the ACA was intended to cause,

with insurance exchanges for Americans who cannot get affordable health benefits through employment achieving the remainder.

However, during a case challenging the law’s constitutionality, the Supreme Court in 2012 upheld the ACA but ruled that every state could decide whether to expand Medicaid.

In the beginning, Republican opposition has centered on the fraction of the expense of expansions that falls on states.

For the primary three years starting in 2014, the federal covered the whole cost of insuring the extra Medicaid recipients that the law made eligible.

Federal the money covers 94 percent of the value and is scheduled to taper off to 90 percent in 2020.

Expansion proponents counter that it brings additional federal money into states while diminishing the amount of poor uninsured residents unable to pay hospital or doctors’ bills.

Since the expansion began, researchers are examining its effects.

Studies consistently show that the speed of uninsured people has dropped further in expansion states.

And despite shortages in some areas of doctors willing to treat people on Medicaid, studies have shown that expansion is related to improved access to worry, including treatment for mental-health disorders and opioid addiction.

Compared with non-expansion states, those with more-generous Medicaid programs tend to possess fewer infant deaths, and cancers are detected earlier.