Medicaid Expansion in Red States

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Health care proved to be a significant issue in the 2018 midterm elections throughout the country. According to Annie Lowery, writing in The Atlantic in November, the Affordable Care Act (“Obamacare”) “came up in more than half of Democratic ads and nearly a third of those for Republicans,” a  much higher rate than in the 2016 election cycle.

In a grotesque twist on the 2018 health care debate, a number of Republican incumbents who have consistently voted to kill the ACA blatantly lied during their re-election campaigns to try to convince voters that they were on their side when it came to preexisting conditions. Lowery reports that Senator Dean Heller of Nevada (defeated for re-election), Senator Ted Cruz of Texas (re-elected in a close contest with Beto O’Rourke), Wisconsin Governor Scott Walker (defeated for re-election), and California Representative Dana Rohrabacher (defeated for re-election) were among the elected officials trying to lie their way back into their jobs on the health care issue.

When the ACA was first passed in 2010, many states took advantage of the Act’s provision to expand Medicaid. Since then, research has shown that expansion has provided many positive benefits for millions of Americans. Voters in several states voted to expand Medicaid, but their Republican Governors refused to enact it. Kansas is one example: expansion legislation was passed by the Kansas House and Senate in 2017 but was vetoed by then-Governor Sam Brownback. Maine has endured a similar fate, according to the Kaiser Family Foundation: “Medicaid expansion was adopted in Maine through a ballot initiative in November 2017. After resisting implementation of the expansion, [Republican] Governor Paul LePage complied with a Maine Supreme Judicial Court order to submit an expansion state plan amendment (SPA) to the federal government in September 2018, but he accompanied it with a letter asking CMS to reject the SPA.” Under the newly-elected Democratic Governor, Janet Mills, Maine citizens will now finally have expanded Medicaid. Thirty-seven states and the District of Columbia now have Medicaid expansion.

As of the 2018 midterms, citizens in three very red states – Idaho, Nebraska and Utah – have passed ballot initiatives on expanded Medicaid. When enacted, the program will potentially increase the number of insured individuals in these states by 330,000. (Montana’s ballot initiative did not pass.) It can be argued at this point in time that Republican lawmakers are those most opposed to Medicaid expansion – and their arguments are usually around cost. According to Rewire.News, “Opponents of expansion argue the policy would prove a drain on state coffers, even though the federal government in 2018 will pay for 94 percent of the cost of expansion.” As Kaiser points out concerning at least two cost-related issues, “Medicaid expansions result in reductions in uncompensated care costs for hospitals and clinics as well as positive or neutral effects on employment and the labor market.” But there are even more positives: “expansion is associated with infant mortality rate reductions, increases in cancer diagnosis rates (especially early-stage diagnosis rates), increases in prescriptions for and Medicaid coverage of medications to treat opioid use disorder and opioid overdose, and reduced probability of hospital closure (particularly in rural areas).”

In short, Republican and conservative arguments against Medicaid expansion based on cost do not hold water. Rather, they use false economic reasoning to hide worn-out ideologies – the old “that will plunge us into Socialism!” (Sometimes the “fear of Socialism” argument is quite blatant.) As we have noted many times before (“What do you Pay for Health Care?”;  “MSNBC Bashing Health Care Myths;” “Revisiting Quality-of-Life Issues in Our Sister Nations”), the government-run health care systems operating in most of the advanced democracies – nations that actually have capitalist economies but temper its excesses with robust social safety nets for their people – are vastly superior to ours in almost every way.

With regard to the recent court decision that ostensibly declares the whole ACA unconstitutional, most commentators and experts feel that this will have virtually no effect for a long time, if at all. The decision is being appealed, and the appeals will take several years to wind through the process. Even if the decision gets to the Supreme Court – and even in the face of Trump’s most recent conservative justices – the ACA is unlikely to be overturned, for a number of reasons.

It is clear – except to diehard conservatives who are blind to reality and pragmatism and often grossly insensitive to the real lives and needs of many Americans – that the pendulum is swinging in our country toward a radically different health care system than we have had in the past. The proposal of Medicare-for-All of the supposed “far left” may not be as dangerous as it is sometimes made out to be, and it is certainly not unpopular: recent polls show that 70 percent of Americans want it! We as a nation need to continue along the single-payer health care trajectory and, as citizens, we need to keep the pressure on our elected officials to ensure that we never return to the “way it’s always been.”