Right now as I am looking for coffee, Medicaid had a pretty good night.
The biggest of course is that the House flipped. Unless there is a rapid reconciliation package, Medicaid as a fundamental shared federal-statement commitment is safe for another two years.
There were four Medicaid expansion referendums. Three states were voting to expand. Montana was voting to continue expansion funded by a tobacco tax.
Funding Expansion via a tobacco tax in Montana is failing. The Montana legislature and governor will now need to figure out what they want to do next.
The next round of Medicaid Expansion stories is in the governors races in Kansas and Maine.
The big surprise (to me) is that the governorship of Kansas flipped:
Laura Kelly (D) defeats Kris Kobach (R) for Kansas governor, NBC calls.
— Sahil Kapur (@sahilkapur) November 7, 2018
The Kansas Legislature has voted to expand Medicaid several times over the past couple of years. Each time it was vetoed. The Legislature never had quite enough votes to override the veto. That will no longer be a problem.
Maine voted to expand Medicaid in November 2017. Governor LePage (R-ME) has refused to implement Expansion despite court orders. The new Governor-elect of Maine, Janet Mills, ran heavily on expanding Medicaid. She will be working as part of a Democratic trifecta that will want to expand Medicaid.
Now there are some longer shots. The one that I am interested in and will learn more about quickly is in North Carolina. Neither chamber flipped. Republicans still control the legislature. The governor is a Democrat. However, the legislature will not be dual super-majorities. The governor’s opinions are now relevant. He has demonstrated a desire to expand Medicaid. There may be space to agree to a Virginia like expansion. I think this is the lowest probability of a new expansion but it is far more plausible today than it was on Monday.
Finally, out West, Medicaid buy-in has become very real in the next three years. Democrats took news trifectas in two states; New Mexico and Nevada. New Mexico has been working hard for a Medicaid buy-in program for a while. US of Care (Andy Slavitt’s new group) is looking to hire up a coordinator for that effort in New Mexico. Nevada’s Democratic legislature passed Medicaid Buy-in (AKA “SprinkleCare”) in 2017 but it was vetoed by the Republican governor. The Republican governor is being replaced by a Democrat. Medicaid buy-in will require significant planning time, but now there are two states that have expressed very strong interest in exploring this policy path.
Overall, last night was a good to very good night for Medicaid.