Medicaid Expansion Gains Momentum

Abstract

Health care was rated one of the key issues for voters in the 2018 midterm elections, according to exit polls. The election results set the stage for as many as 500 000 low-income individuals in the United States to gain coverage through new state Medicaid expansions under the Affordable Care Act (ACA). Expansion could occur in 5 additional states: 3 through ballot measures (Idaho, Nebraska, and Utah) and 2 through the election of new governors supportive of expansion (Kansas and Maine). If all 5 states expand Medicaid, this will bring the number of expansion states to 37 (plus Washington, DC), with a potential increase in Medicaid enrollees from approximately 50 million in 2010 prior to enactment of the ACA to a projected 76 million by 2020 (Figure and eFigure in the Supplement). The election also brings some short-term legislative certainty for the ACA, as the new Democratic majority in the House of Representatives will forestall further attempts to repeal the law for at least 2 years. In this Viewpoint, we provide a postelection update on the status of the Medicaid expansion and recent research on the ongoing effects of the law.Two gubernatorial elections will likely result in new state Medicaid expansions. Maine became the first state to expand Medicaid through a ballot initiative in Decem-ber2017,butRepublicanGovPaulLePagerefusedtoimplement the program, despite court orders to do so. Democrat Janet Mills campaigned on expanding Medicaid, and her election creates a clear path forward for the expansion. Although such projections are inherently imprecise, policy analysts estimate that Medicaid expansion in Maine could cover an additional 56 000-72 000 individuals (eTable in the Supplement). Medicaid expansion is also a strong possibility in Kansas, where newly elected Democrat Laura Kelly is committed to expansion. She will have the likely support of the Republican-controlled legislature, which passed a Medicaid expansion bill in 2017 that was vetoed by then Gov Sam Brownback. Medicaid expansion in Kansas could provide coverage to an additional estimated 129 000-152 000 Kansans. Wisconsin also elected a new governor, Democrat Tony Evers, who has indicated support for expanding Medicaid, although the state's legislature remains opposed, making an imminent expansion in Wisconsin unlikely.Ballot initiatives supporting Medicaid expansion were successful in 3 states, although as in Maine, expansions in thesestatescouldbeblockedbystateofficialswhooppose the change. However, if the initiatives are implemented, Utah is expected to experience the largest Medicaid coverage expansion, with an estimated 100 000-158 000 new beneficiaries. The Utah ballot measure finances the program through an increase in the state sales tax, which is expected to cover the full $77 million projected annual cost to the state of expansion. In Idaho, an estimated 51 000-119 000 individuals are expected to enroll in Medicaid, at a projected annual cost to the state of $39 million to $42 million. In Nebraska, an estimated 68 000-93 000 individua...

US Health Policy—2020 and Beyond

“…6 Medicaid has expanded substantially with the passage of the Affordable Care Act, with an increase in the number of individuals covered from approximately 50 million in 2010 to an estimated 76 million by 2020, as additional states have indicated that they will expand Medicaid. 7 Across these payers, how does the United States spend $3.5 trillion in health care dollars? Various estimates are available, but overall, hospitals account for approximately 33% of spending, 1,2 physician and clinical services approximately 20%, 1,2 and prescription drugs (including retail, ambulatory, and hospital costs) about 18%.…”

“…Although children represent approximately 44% of Medicaid recipients (34 million of a total of 72 million), they account for only approximately 19% of the cost . Medicaid has expanded substantially with the passage of the Affordable Care Act, with an increase in the number of individuals covered from approximately 50 million in 2010 to an estimated 76 million by 2020, as additional states have indicated that they will expand Medicaid …”

JAMA Health Forum—A New Channel of Information

“…And a fundamental question—is health care a right or privilege?—remains unanswered. While many in the United States receive exceptional care and about 20 million fewer individuals are uninsured following enactment of the Affordable Care Act (ACA), the number of uninsured is again increasing, now close to an estimated 27.5 million or 8.5% of the US population . Financial support for health and health care is also a growing challenge for low-, middle-, and high-income countries around the world.…”

Medicaid Expansion and Birth Outcomes

“…One of the great successes of the Affordable Care Act has been the expansion of Medicaid. In large part due to this expansion, the number of individuals in the United States with health care coverage has increased by about 25 to 30 million since 2011; following midterm elections, it is likely that additional Medicaid expansion will occur …”