If you remember, I wrote about Oklahoma squeaking through its own initiative to expand Medicaid for low-income people. In theory, the state will be in the driver’s seat (mostly) in deciding how much money it will allocate to the program rather than the Federal government. Political interests will have a difficult time killing Medicaid without another ballot initiative to override what The State Question 802 initiative was passed by a margin of less than 1 percentage point amongst voters.
This last week, Missouri approved the expansion of Medicaid for many of the state’s poorest adults up to 138% FPL (which is 90% funded by the Federal Government. The expansion under Missouri Amendment 2 makes their conservative state the second to join the ACA through a ballot imitative changing the Missouri constitution during the pandemic.
The Missouri ballot measure expands Medicaid to about 230,000 low-income residents at a time when the state’s safety net health care program is already experiencing an enrollment surge tied to the pandemic’s economic upheaval. If you are unemployed you may qualify for Medicaid if you have income less than 138% FPL. Medicaid looks at current income and not annual income. The Medicaid expansion measure was supported by 53 percent of voters.
Fairness Project and the United Healthcare Workers Union West
Backing these initiatives is a nonprofit organization called the Fairness Project which grew out of the frustration of healthcare strategists with 19 states, governed by Republicans, refusing to pass the Medicaid Expansion . . . which from the start of the ACA covered Medicaid expansion costs at 100% up till the end of 2016 and then gradually decreased to 90%.
A memo written by a California union leader in 2014, warned of steep declines in union membership potentially could leave workers unprotected with fewer benefits.
Dave Regan, president of United Healthcare Workers West, a union of 95,000 hospital workers; “Unionism is in decline, and there is no end to that in sight. We still need to give regular people the opportunity to have positive change in their lives.”
Regan proposed creating a nonprofit to promote the ballot initiative process to secure policies that would benefit workers, like increased access to health coverage and a higher minimum wage.
“Ballots are an opportunity to put a question, in its undiluted form, in front of millions of people as opposed to traditional legislative work, where things get watered down to get out of committee. You end up with what you actually want when you use the ballot.”
The Fairness Project came into existence in 2016 with initiatives to increase the minimum wage in both California and Maine. The following year it returned to Maine to work on healthcare and Medicaid. Five times, the Maine legislature passed bills to expand Medicaid and each time they were vetoed by Gov. Paul LePage. Efforts to override the veto failed by a vote or two each time.
Working on its passage, the Executive Director of Maine Equal Justice, Robyn Merrill gathered enough signatures to secure a spot for its initiative on the 2017 ballot for a yea or nay vote. With the help of Fairness Project funding for advertising, securing data as to which voters to target, and gathering information as to how to reach them; the Maine campaign succeeded, with 59 percent of voters supporting the Medicaid expansion.
The ballot initiative does have its weaknesses as governors such as LePage (Maine) will delay implementation (left office and then implemented) or add work requirements such as Utah did. Utah’s Republican legislature and governor, twisted, turned, and finally enacted a partial expansion up to 100% FPL, effective in April 2019 only to have the Centers for Medicare and Medicaid Services reject their proposal. The rejection focused on a waiver to apply the ACA’s 90% federal match rate to a limited expansion population of 90,000. Utah went to a full expansion effective Jan 1, 2020, with a work requirement which was suspended in April 2020 in response to the pandemic.
Of the 11 remaining states that have not decided to expand Medicaid, only four have referendum processes: Florida, Mississippi, South Dakota and Wyoming. The Fairness Project has been working with Florida advocates for expansion for 2 years now and will push to have it on a ballot in 2022. Florida has 2.7 million uninsured residents.
Missouri Expands Medicaid, Using Progressives’ New Tactic: Ballot Initiatives. NYT Upshot, Sarah Kliff, August 4, 2020