Multiple Red States Will Vote on Medicaid Expansion This Election Day

Utah, Nebraska, Idaho and Montana will all have Medicaid expansion-related measures on their ballots next week. In the meantime, voters are deciding whether they want to join 33 states and Washington, D.C., in taking advantage of this popular Affordable Care Act program.

Medicaid expansion can extend health coverage to millions of people who currently make too much for Medicaid, but not enough to afford insurance on their own. Even as voters head to the polls, though, the Medicaid program itself is under threat — and that makes it difficult to determine how many benefits people will actually be able to access if they vote yes.

The benefits of Medicaid expansion for low-income people are clear — one reason Maine residents have been engaged in a vicious fight over the topic with a governor who refused to hear their clearly-expressed wishes on the subject.

Conservative states that have opposed Medicaid expansion, like Maine, are resisting for a number of reasons — including claims that it’s “unsustainable,” leaving millions of dollars in federal funding on the table as they walk away. Proponents of expansion suggest that leaders may be opposed in part because it’s an Obama-era program, and refusal to engage may be rooted in spite.

Maine was the first state to put the matter on the ballot, and this year shows that it won’t be the last — Virginia voted to adopt Medicaid expansion during their primary earlier this year.

And while Maine’s governor, Paul LePage, has fought tooth and nail, Idaho’s Republican governor has adopted a different tack, appearing in campaign ads supporting the proposal.

A growing number of conservatives are coming around to the cause, seeing the clear benefits in other states. In Medicaid expansion states, 7.5 percent of adults lack health insurance, in contrast with 16.1 percent. People also have better access to preventative care and other benefits that keep them healthy, while reducing health care costs.

But even as voters go to the polls, there’s a shadow looming over the outcome of the election.

Medicaid has become a popular target for conservative lawmakers on the federal level, who are threatening policy changes that could gut Medicaid expansion — including simply rolling back the popular ACA provision, along with other elements of the law. ACA sabotage is already costing voters, with premiums spiking in 2019 thanks to volatility in the health insurance market.

Even if conservatives don’t claw back Medicaid expansion, making the work of all these organizers moot, they’re not done. Some have proposed switching the program to block grants or per capita caps — and if that language sounds like gobbledygook to you, you’re not alone.

Currently, states and the federal government partner with matching funds to provide Medicaid coverage to all those who are eligible, with no ceiling. If people are entitled, they’re covered. Under block grants, the federal government would dispense a lump sum based on calculation of need and future adjustments for inflation.

Once that money is gone, it’s gone, and states will be left picking up the slack. This could lead to state-level changes to eke out funds, changing the implementation of Medicaid to make it more restrictive and less beneficial.

Meanwhile, with per capita caps, funding would be limited per enrollee — whether individual or based on groups. As with block granting, once the money runs out, it’s done — and that incentivizes states to cut costs via any means possible. This move could hurt disabled people and others with complex medical needs, and erode a variety of valuable Medicaid programs.

Some of these programs might surprise people. For example, Medicaid provides funds that support special education, and funding cuts could harm disabled students. Medicaid also supports Home and Community-Based Services, which extend care to disabled people who need support in their own homes. Cuts to the program could force people into costly and isolating nursing homes. And Medicaid offers extensive care for pregnant people, promoting prenatal and post-partum care.

As voters head to the polls on Tuesday to consider Medicaid expansion, they may want to think about their up-ballot votes as well. Who they vote for could influence whether Medicaid expansion will be available in the future — and how much money will be made available if it is.

Photo credit: AFGE/Creative Commons


Shirley S
Shirley S5 months ago


Rhoberta E
Rhoberta E5 months ago

Typo (grammatical error :-)
In my post to david f , it should be for him "KNOW NOTHING NEWS".
Thank you

Rhoberta E
Rhoberta E5 months ago

david f
Does your resident "health care worker" STILL give you confidential information?
I Wonder why Canadians have a longer life span than US citizens? Probably because folks like YOU are ONLY concerned about what YOU have and don't give a rat's behind about your fellow US citizen !!!
We have been through your mistruths about health care in other countries and your response is ALWAYS the same. NO NOTHING NEWS !!!

David F
David F5 months ago

Colin C. You may be happy with universal healthcare however that does not mean you are better off. You pay one way or the other, but your government takes a huge cut. You don't know what you don't know.

The most important diagnostic machine available to a doctor is a Magnetic Resonance Imaging, (MRI) it's a great tool to judge the health of healthcare.

Units per million population in the USA is about 40, in Australia it's about 20.

Unfortunately they can cost millions each. What the United States does not want is to go backwards and quality and quantity with government controlled health care.

David F
David F5 months ago

Debbie W, I understand your mindset that you believe everyone that disagrees with you is a bigot and a racist, however you should understand simple math and history.

There is no way we can have Medicaid for all unless we devastate the healthcare the children and elderly are getting now. Debbie, you are either without thought, or very cruel to the disadvantage.

The government does not add doctors and nurses and hospitals, it can only take away as it did in Obamacare where it raised prices, lower quality and quantity dramatically for all.
Fake news doesn't cover where Vermont tried universal healthcare and Hawaii to a certain degree. Both were a complete failure. The government adds nothing to healthcare, it can only redistribute after it takes its own highly inefficient bureaucratic cut.

Colin C
Colin C5 months ago

Free Universal Health Care works for me here in Australia.

Clare O
Clare O'Beara5 months ago


Olivia M
Past Member 5 months ago

Thank you

hELEN hEARFIELD5 months ago


Lisa M
Lisa M5 months ago