Medicaid Expansion 2018

Four states had the Medicaid Expansion on the ballot this last election and another is still fumbling around with expanding it..

The Good

Idaho: Idahoans approved Idaho Proposition 2, an initiative requiring the state to submit an amendment to the Centers for Medicare and Medicaid Services (CMS) in order to implement the Medicaid expansion no later than 90 days after the approval of the act. The Idaho Department of Health and Welfare is required and authorized to take all actions necessary to implement the provisions of this section as soon as practicable and outgoing Governor Butch Otter endorsed the ballot initiative less than a week before the election and Republican Governor-elect Brad Little has said he will implement the initiative.

Nebraska: Nebraskans voted in favor of Initiative 427 requiring the state to submit an amendment/documents seeking waiver approval from CMS on or before April 1, 2019 to expand Medicaid. As directed by the initiative, the state Department of Human Services to “take all actions necessary to maximize federal financial participation in funding medical assistance pursuant to this section”. Although newly reelected Governor Pete Ricketts has been a vocal opponent of expansion, he has stated he would let the voters decide if it made it onto the ballot.

Utah: Voters approved Utah Proposition 3 calling for the state to expand Medicaid coverage beginning April 1, 2019. The initiative also prohibits future changes to Medicaid and CHIP that would reduce coverage, benefits, and payment rates below policies in place on January 1, 2017. The proposition calls for a 0.15% increase to 4.85% from 4.7% the state sales tax (except for groceries) to finance the expansion or Medicaid and CHIP more broadly.

The Bad

Montana: Montanans voted down Montana I-185 after spending on campaigns for and against the initiative made it the most expensive ballot measure race in Montana history. The measure proposed raising taxes on all tobacco products and e-cigarettes and vaping products to dedicate a percentage of increased tax revenues for Montana’s current Medicaid program and veteran’s services; smoking prevention and cessation programs; and long-term care services for seniors and people with disabilities. The initiative also would have eliminated the sunset date for the Medicaid expansion of June 30, 2019. Republican controlled Montana State Legislature could still take action to continue the expansion program beyond June 2019. Tobacco companies had spent more than $17 million on advertising and other efforts to oppose the ballot measure, most of which came from cigarette maker Altria (Philip Morris).

The Ugly

Maine: Maine. Medicaid expansion was adopted in Maine through a ballot initiative in November 2017. Governor Paul LePage resisted the implementation of it and then complied with it after the Maine SC ordered him to submit an expansion state plan amendment (SPA) to CMS. He did submit the plan along with a asking CMS to reject the SPA. The newly elected Democratic governor, Janet Mills, has supported Medicaid expansion and is likely to move quickly to implement. Democrats also control the Maine legislature.

The ACA has shown up more in this last election even though it is pretty much a done deal and near impossible to repeal. Still Republicans repeat the same old “lies” even though they have been shot down repeatedly. One often repeated lie is the Democrats and the ACA stole $800 billion from Medicare to fund it. This lie was used by Mike Bishop in Michigan and our President also. Quite the opposite occurred with the Medicare TF being extended for a few more years and excess payments to Advantage plans reduced to match what Medicare pays out.

More to be read here: What Does the Outcome of the Midterm Elections Mean for Medicaid Expansion?

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