Their campaign now moves to red states like Utah, Idaho, and Nebraska, where activists plan new pushes to put Medicaid expansion on the ballot in 2018. In Alaska, there’s already a movement for state voters to protect the state’s expansion from federal cuts in Congress. “The victory [Tuesday night] is going to fuel a movement across the country to expand and lock in Medicaid and bring health care to millions of people,” Schleifer said in a phone interview Wednesday.
The ACA made billions of federal dollars available to states that increased eligibility for the program that provides health care to poor and low-income Americans. The Supreme Court ruled in 2012 that the expansion must be voluntary for states, and many controlled by Republicans opted out.
Tuesday’s results are also giving new hope for action by state legislatures, where efforts to expand Medicaid have stalled amid fights over ideology and budgetary constraints. In Virginia, outgoing Democratic Governor Terry McAuliffe has been unable to pass a Medicaid expansion through the Republican-controlled legislature. But because of more than a dozen Democratic pickups in local races on Tuesday, Northam could have a narrow majority in the House of Delegates and more leverage to pressure the state Senate, where Republicans have a slim advantage.
And in Kansas, a coalition of moderate Republicans and Democrats could make another push to expand Medicaid when the legislature reconvenes in January. Earlier this year, the state House and Senate fell just a few votes shy of overriding Governor Sam Brownback’s veto on an expansion bill. State Representative Susan Concannon, a Republican who led the Medicaid push, said many supporters were discouraged in the spring and summer by the continued efforts in Congress to repeal Obamacare and felt it was “too late” for the state to expand Medicaid. But with the repeal drive shelved and after the vote in Maine, the dynamic may change. “For us in Kansas, it really is an inspiration that they were persistent,” she told me on Wednesday. “It’s something that we can point at as a success.”
The most surprising development in the health-care wars, however, may be happening in the marketplace rather than the ballot box. According to data released Thursday morning by the Trump administration, enrollment in the Obamacare insurance exchanges surged during the initial days of this year’s sign-up period, which began November 1. Analysts had expected enrollment to fall amid reports of sharp premium increases and a decision by the Trump administration to slash the budget for outreach and advertising by 90 percent. In response, ex-Obama administration officials set up their own public-awareness campaign, which included a video recording by the former president.
But those involved in the effort attribute the spike in enrollment to a quirk in the way the Trump administration has managed the law. Trump’s decision to withhold payments to insurers ended up triggering higher direct subsidies for consumers. As a result, people in some areas can find high-deductible plans with much lower premiums, or even no monthly payments at all. “For many people, the premiums are lower than they ever have been before,” said Lori Lodes, co-founder of the advocacy group Get America Covered. The additional cost is to taxpayers, meaning the Trump administration’s decisions are ultimately increasing the federal government’s hand in health care, at least in the short term.