Nov 9

Nov 9 Maine Votes to Expand Medicaid By Nicky Riordan

The Affordable Care Act (ACA) has undoubtedly impacted healthcare in America irrespective of what may become of the law moving forward. This ongoing series highlights the legacies of the ACA, beginning with the most obvious and then shifting to more subtle changes.

In an unprecedented show of public support Tuesday, Maine voters signaled the changing public perception of the ACA and supported a measure to expand Medicaid statewide by nearly 60 percent. This was a notable victory for proponents of Medicaid expansion, but it should not come as too much of a surprise.

Recent polls have shown that 73 percent of individuals living in states without Medicaid expansion have a favorable view of the program, and 53 percent of Republicans oppose decreasing federal funding for Medicaid. Governor Paul LePage is already pushing back against the outcome of Question 2, but it is clear that the ACA’s Medicaid expansion has become a sticking point for the health care debate moving forward.

Prior to passage of the ACA, Medicaid eligibility was limited to specific populations, such as low-income children, pregnant women, and elderly and disabled individuals; but one of the most controversial and impactful provisions of the law included expanded Medicaid eligibility to all adults under 65 with incomes below 138 percent of the federal poverty level. Although a June 2012 Supreme Court ruling made this expansion optional for states, 31 states and the District of Columbia had expanded coverage as of August 2017.

In addition to this expansion, the ACA strengthened the program in important ways that further increased enrollment, including modernized and simplified enrollment processes, and improved outreach for the program. Unlike other forms of insurance coverage, individuals can enroll in Medicaid throughout the year and there is increased assistance for those who are eligible.

According to the Centers for Medicare & Medicaid Services, these changes have resulted overall in a 38.5 percent increase in enrollment in expansion states, including ranges of up to 106 percent in high poverty states like Kentucky. The largest portion of this increase came from the 77 percent of new enrollees who became eligible after the ACA. This is important because the expansion of the program under the ACA has reduced national bankruptcy rates, hospitalizations, and even mortality rates in some cases.

State adoption of Medicaid expansion has slowed significantly following the election of Donald Trump and increasing uncertainty about the future of the law. At the same time, repeal proposals including Medicaid cuts or an end to the expansion were a nonstarter, even among Republicans. This effort was led primarily by Republican Governors who saw the direct impact Medicaid expansion was having on the health of their residents and the solvency of their budgets.

Indeed, the Medicaid expansion has benefited many rural, low-income families and individuals with mental health and substance abuse issues, making it a popular provision in red states. Republican Governors such as John Kasich of Ohio and Bill Walker of Alaska put their Senators in a precarious position when they came out against the most recent repeal effort in September, making passage of such a proposal impossible.

In addition to expanding coverage, the crafters and advocates of the ACA aimed to change the overall conversation around health insurance in the United States to ask the question: is healthcare a right, or a privilege? Multiple failures to repeal the ACA due to fervent opposition to Medicaid cuts or an end to the expansion, paired with the recent outcome in Maine, suggest that the American public is perhaps moving toward the former. Expanded Medicaid eligibility seems to be here to stay for the foreseeable future.

Nicky Riordan (@nriordan120), Political Analyst, Utica College Center of Public Affairs and Election Research