Medicaid expansion and the election

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.

Utah, Nebraska and Idaho all voted to expand Medicaid last night. 

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:

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.

16 replies
  1. 1
    Baud says:

    There’s also the herd immunity that comes with more people invested in the system.

  2. 2
    Cermet says:

    A good night period! Dems are gaining back their power across the spectrum and with the House under strong control, and the Census in 2020, looking up. The ACA is safe now and will only get safer with time. The Senate looks better for Dems in 2022 so, then with a Dem President, and winning the Senate, a real bill to address medical care for all Americans will be tackled.

  3. 3
    guachi says:

    Democratic legislators lose elections for their votes. Then people end up liking the results, anyway. See: 1993 tax bill that resulted in surpluses and 2010 Obamacare.

  4. 4
    cain says:

    In two years, we are going to take back both branches of govt. The judiciary is going to be lost to us unless we also make sure that we focus on judges going forward as well.

  5. 5
    cain says:

    I wonder what our blog host thinks? I haven’t heard a peep out of him.

  6. 6
    Steeplejack says:

    Typo in the second graph: “Medicaid as a fundamental shared federal-statement commitment.” Presume you mean “federal-state commitment.”

  7. 7
    Ohio Mom says:

    I seem to need constant reminding that last night really was great news (and I know it was!) because I remain very bummed out by my fellow Ohioans.

    We passed an anti-gerrymandering effort a while back but now that is going to be overseen by Republicans. Which bodes very poorly.

    My state is on the wrong track.

  8. 8
    guachi says:

    Yeah, Ohio is too gerrymandered. No gains in the House and of the four Democrats in the House the lowest margin of victory was something like 22 points.

    The anti-gerrymander ballot initiative is weak tea as it’s not nonpartisan.

    As I understand, if Democrats and Republicans can’t come to an agreement the Republicans (since they control everything) can pass whatever they want and the only real consequence is the map doesn’t last 10 years.

  9. 9
    rikyrah says:

    I knew that you would break it down for us, Mayhew. Thank you 😄🐢

  10. 10
    artem1s says:

    IMO I’m OK with losing the Senate (unlikely anyway) because of the state level races that Dems won. In the long run they will mean more to taking back the democracy than winning one celebrity campaign that wasn’t going to flip the majority anyway. First AA woman House member for MA, Kobach losing KS, LGBT candidates, Native American candidates, etc. Huge wins for non-traditional, non-white, non-cis-male candidates. The country is arcing in a different direction and the GOP can’t stop it. When you’re losing KS, you’re in trouble.

  11. 11
    L85NJGT says:

    Only 14 remaining.

    Hopefully with the Wisconsin Gov. result they can get something done.

  12. 12
    Mai Naem mobile says:

    The Dems need to take credit for Obamacare. I sincerely believe many Americans don’t know that the Dems are responsible for the different pieces of the social safety net. I remember talking to somebody about Medicare and Medicaid during the Obamacare fight and they really thought Ronald Reagan passed them. This shot of you’re lucky is taught to you in HS when you may not really he interested in this stuff.

  13. 13
    Joe Falco says:

    I keep checking back on the Georgia gubernatorial race, hoping that there will be enough votes coming in for Abrams that there will be a run-off. I’m so energized to, if anything else, keep that cheater Kemp from stealing the race.

  14. 14
    Jerry says:

    Mayhew, I’m actually kind of excited for North Carolina right now. We need to start some sort of letter writing campaign to get the Medicaid expansion idea presented by our governor. How do we start this? Is something that us local NCians can have a meet up for? Or do you think ol’ Roy is at it already?

  15. 15
    Paul W. says:

    Thanks David! I am feeling much better today than last night after I got over the fact that a strong wave (breakeven Senate, FL + OH + GA? Gov) was not in the cards.

    The House did quiet well, again not as strong as I hoped but some important pickups and we almost took down King, and state legislatures plus the ballot initiatives are very favorable.

    It’s enough to keep me going, and the disappointing yet inspiring and totatalllyy worth it Beto run in TX means we can open up some more chinks in the GOP armor there as well.

  16. 16
    wuzzat says:

    @cain: Things didn’t go so well in WV. This is unsurprising, but probably frustrating. If I were JC, I’d probably be aggressively cuddling my critters until my blood pressure dropped a few points.

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