Even as the Trump administration seeks to slash Medicaid funding, more and more states are buying into the expanded program.
In the run-up to the mid-terms, Medicaid expansion was literally on the ballot in four states, and numerous gubernatorial candidates were running with the pledge that they'd expand Medicaid under the Affordable Care Act if they won. When the dust cleared, the voters of three states—Idaho, Nebraska, and Utah—had passed their ballot initiatives to expand the program. (Montanans voted no on the funding expansion, but had previously voted yes on accepting federal funds in 2016, so the program's future there is unclear.) New Democratic governors in Wisconsin and Kansas are poised to push for Medicaid expansion. Maine approved expansion by ballot initiative in 2017, but Republican Governor Paul LePage fought the measure. The new Democratic governor, Janet Mills, is now pushing expansion forward. The 2017 Virginia elections that swept so many Democrats into state office also paved the way for Medicaid expansion in that state as of January this year.
Across the country, hundreds of thousands of low-income Americans will now qualify for Medicaid.
Medicaid expansion has proven to be one of the most effective ways of expanding access to health care in the era of Obamacare. Last March, the Kaiser Family Foundation published a major meta-study of relevant literature and concluded, "Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates, among the low-income population broadly and within specific vulnerable populations." What's more, the economic outcomes are generally positive: State expenditures remained flat through 2015 (but have likely move up since then, as federal funding dropped from 100 percent to 90 percent). But even with more state expenditures, "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."
Before the election, the Center for American Progress estimated that 14,000 lives would be saved every year if all hold-out states expanded Medicaid. Thanks to the elections in 2017 and 2018, the number of states without expansion is down from 19 to just 14. Those holdouts include Oklahoma and the entire southeast. Meanwhile, that region has the lowest life expectancy in the county.
Until American health care becomes truly universal, Medicaid expansion is the best way for states to supply medical access to the most vulnerable populations. Elected leaders in non-expansion states are risking the lives of the people they have been chosen to represent.