Not on the ballot: Medicaid expansion
The focus of so much fierce campaigning and ardent politicking at the state level in the past few elections, Medicaid expansion, is taking this November off.
Oklahoma voters approved a Medicaid expansion ballot measure in June, and Missouri voters approved one in August. The issue may make it on to the ballot in Florida in 2022; an organizing committee there decided to delay their target till then. Democrats in South Dakota are also eyeing 2022 as the year they will be ready to put Medicaid expansion in front
“Given the success of Medicaid expansion through ballot measures in states where governors or legislatures opposed expansion, we should expect to see the same tactic attempted in some of the remaining states,” says Philo D. Hall, a senior counsel in healthcare and life sciences practice at Epstein Becker Green law firm and a HHS lawyer during the George W. Bush administration. The more time that passes from passage of the ACA in 2010, the more palatable Medicaid expansion becomes for many voters who opposed “Obamacare,” Hall says.
Still, there are plenty of entanglements in politics of Medicaid expansion in the 12 remaining nonexpansion states. In Kansas, the Democratic governor and the Republican Senate majority leader agreed to a compromise proposal, but it was eventually blocked, partly because of anti-abortion politics. In North Carolina, the Democratic governor and Republican-controlled legislature waged a drawn-out, back-and-forth battle over the state budget; the main issue was Medicaid expansion. Complicated by COVID-19, the political maneuvering stumbled to an end with no decision reached.
These state-by-state skirmishes are occurring against the backdrop of the entire ACA again being in legal jeopardy. The California v. Texas case, which could result in a ruling throwing out the entire law, is scheduled to be argued before the Supreme Court in November. The death of Justice Ruth Bader Ginsburg leaves three reliably liberal justices on the court, although some experts say the main legal issue in the case, severability, would not necessarily split the justices along liberal-conservative political lines.
Matt Salo, executive director of the National Association of Medicaid Directors, says the ACA has always been under an existential threat. “At the core of it is politics, and it (the ACA) has nuances that don’t necessarily play well with politics. The ACA is separate from Medicaid expansion and is an emblematic issue that has rallied conservatives in opposition.”