Despite all of the drama surrounding the 2018 midterm elections, one thing was clear: Medicaid had a big night on November 6, 2018.
In particular, the electorate in the Red states of Nebraska, Idaho, and Utah voted to expand Medicaid (i.e. extend Medicaid coverage to low-income able-bodied adults). Although the Montana electorate rejected a ballot measure that would have permanently funded the Medicaid expansion in that state beyond 2019, it’s worth noting that much of the opposition against this measure came from the tobacco industry (the Medicaid expansion would have been funded by an excise tax on tobacco sales).
Furthermore, gubernatorial victories for the Democrats in Kansas, Maine, and Wisconsin suggest that a Medicaid expansion in those states may be coming.
- The Kansas legislature approved Medicaid expansion in 2017, but then Republican Gov. Sam Brownback vetoed it, suggesting that the governor-elect Laura Kelly may sign off on another effort.
- In Maine, the voters approved a Medicaid expansion in 2016 via a ballot petition, but outgoing Republican Gov. Paul LePage refused to implement it, prompting a legal battle. Governor-elect Janet Mills, who has vocally supported expanding Medicaid and tangled with Gov. LePage over Medicaid policy, is expected to move forward with implementing Medicaid expansion. (Ironically, Governor LePage’s former Commissioner of Health and Human Services is now a Deputy Administrator at CMS, responsible for running the Center for Medicaid and CHIP Services).
- In Wisconsin, Democratic governor-elect Tony Evers defeated Republican Gov. Scott Walker, in large part on a platform of expanding Medicaid. However, unlike the other states cited above, the state legislature has not approved a Medicaid expansion and it remains under the control of Republicans. Thus, Medicaid expansion in Wisconsin is much more uncertain.
All in all, as we saw during the Republican-led Congress’ effort to repeal and replace the Affordable Care Act (and block granting Medicaid), the Medicaid program – and the ACA expansion of the program in particular – has proven to be resilient.
However, there is one important thing to keep in mind here: even as Nebraska, Idaho, and Utah will be expanding Medicaid, it is possible that they will do so with a conservative flavor. Indeed, we have written before about the numerous Republican twists on Medicaid expansion (here, here) through section 1115 waivers. If the past is any predictor of the future, we expect to see similar conservative requirements attached to these new Medicaid expansion states.