Medicaid Expansion Gains Popularity

boy at doctor

Louisiana’s former governor Bobby Jindal resisted expanding Medicaid under the Affordable Care Act until the bitter end, refusing even to discuss preparing for the expansion in the waning days of his administration, even though his successor, Democrat John Bel Edwards, had promised to enact it on his first day in office. Jindal and his fellow red-state ideologues argued that it would be too expensive and that he was opposed to government-run health care.

But Edwards followed through on his pledge when he took office in 2016, and a new report released this week says that Louisiana’s expansion of Medicaid led to a $1.85 billion direct impact for the state, according to the Times-Picayune.

Since the Republican push to roll back the Medicaid expansion program with their failed health care bills last year, other states have been rethinking their refusals of Medicaid expansion. Utah’s legislature approved an expansion of the Medicaid program this spring, though its law includes work requirements and and only makes residents eligible up to 100 percent of the poverty level (rather than the 138 percent required by the ACA). That means it would require federal approval, but even in its current state the new law would cover 70,000 more of the state’s poor residents. But Utah will also have a ballot initiative proposing a full Medicaid expansion up for a vote in November, and recent polls show that two-thirds of Utah voters support it.

Voters in Maine passed a ballot initiative expanding Medicaid last November that’s so far been held up by its Republican governor (and resident loose cannon) Paul LePage, and activists in Nebraska, Idaho, and Missouri are currently working to get measures on their November 2018 ballots.

Virginia appears likely to expand the program to 400,000 low-income citizens soon. Its Democratic governor, Ralph Northam, made Medicaid expansion a front-and-center topic during his campaign, and the Republican-led legislature has been increasingly tolerant of the idea in recent weeks.

The Affordable Care Act encouraged states to expand their Medicaid rolls by committing the federal government to paying the bulk of the costs, and thirty-two states and the District of Columbia have done so. In the states that refused, most childless adults are ineligible for Medicaid regardless of income level. Plus, anyone earning more than 44 percent of the poverty level (a median of $8985 per year for parents in a family of three) is ineligible. However, Obamacare marketplace subsidies are only available for consumers earning at least 100 percent of the federal poverty level ($12,060 for an individual), because the Affordable Care Act was created and passed on the premise that anyone below that income level would be covered by expanded Medicaid. That means people earning too much for Medicaid but not enough for Obamacare subsidies have no option except to pay full price for an ACA market individual insurance plan. The Kaiser Family Foundation estimates that the health insurance coverage gap includes about 2.4 million adults nationally.

The program’s resurgence in state-level politics shows how the intensive health care conversations that went on during the repeal-and-replace debates last year made Americans more aware of the benefits of government involvement in the health insurance process (Bobby Jindal notwithstanding). The progressive data science organization Data for Progress analyzed survey results early this year showing that there’s strong support for Medicaid expansion, even in heavily Republican states, including Kansas, South Dakota, and Georgia.

What’s more, a study conducted by Yale University last year found that having government-supported health insurance coverage actually makes citizens more politically active: Voter turnout increased in states where Medicaid was expanded, compared to those where expansion has been blocked.

What’s next? If candidates run at the state level on expanding Medicaid so that the absurd and despicable gap in coverage eligibility is finally eliminated (as it was meant to be when the ACA passed originally), voters will see direct benefits and step up their involvement in politics. Once low- and middle-income voters all have their basic need for health care met by a government program, they’ll have the psychological space to ponder how the system could be even better. The next step should be Medicare for All.