By Rebecca Mayo, J.D.
The outcomes of the 2018 elections will shape Medicaid program changes at both state and federal levels of government. Medicaid is the largest source of federal revenues for states and provides health insurance coverage for more than 76 million Americans. According to Kaiser Family Foundation Issue Brief, the Congressional and gubernatorial elections as well as key ballot initiatives all have the power to change how the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) and Medicaid are implemented in each state.
Congressional races. One year ago, Congress was debating repeal and replacement of the ACA. A shift in the composition of Republicans and Democrats in the Senate and House could influence whether Congress considers legislation related to the ACA including Medicaid expansion and Medicaid financing caps. Incumbent Democratic candidates in Missouri, North Dakota, and West Virginia are running on protections for people with preexisting conditions, while Republican challengers in Missouri and West Virginia are state attorney generals who signed on to the legal challenge to the ACA in Texas v. Azar.
Gubernatorial races. In Michigan, the outgoing Republican governor signed legislation to impose a work requirement in Medicaid, however a newly elected governor could choose to move forward with this plan or work against it. The gubernatorial races in 36 states could determine whether those states expand Medicaid or adopt work requirements in Medicaid. Candidates in key toss-up non-expansion states, such as Florida, Georgia, Kansas, and Wisconsin are making their positions on Medicaid a major part of their platforms.
In Maine, Medicaid expansion was adopted through a ballot initiative in November 2017, however the Governor has resisted the expansion which resulted in an order from the Maine Supreme Judicial Court requiring him to submit an expansion state plan amendment (SPA). After submitting the SPA, the governor asked CMS to reject the SPA. The state’s next governor will determine the outcome of the implementation of the expansion.
Ballot initiatives. Voters in Idaho, Nebraska, and Utah will vote on a measure that would adopt the ACA Medicaid expansion to 138 percent of the federal poverty level. In Montana, voters will vote on a measure that would eliminate the state’s June 2019 expansion program sunset date and raise tobacco taxes to fund the state’s share of expansion costs.
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