Medicaid Expansion On Ballots Across U.S. In Midterm Vote

Andrew Gillum, the Democratic gubernatorial candidate in Florida, says the state has left some 700,000 poor residents without health coverage by refusing to sign up for Obamacare's expansion of Medicaid.

He has vowed to take the money if he wins election.

Elsewhere, voters themselves will get to decide in referendums in some of the nation's reddest states whether to join the Medicaid expansion, turning November into a make-or-break moment for President Obama's signature health care law.

Medicaid expansion has been the quiet workhorse of the law, extending coverage to roughly 12 million people making at or just above the poverty line in dozens of states.

Republicans in Washington have repeatedly looked to rein in the Medicaid expansion as part of their broader efforts to curb the 2010 law.

But a "blue wave" in the November elections giving control of either chamber of Congress to Democrats would end that.

"If the Democrats take the House, repeal of the Medicaid expansion is off the table. Even if Republicans hold the House narrowly, they will have a hard time holding their caucus together for repeal," said Timothy Jost, a professor at Washington and Lee University who tracks the debate.

Democratic gains also might convince state-level holdouts that Medicaid expansion is a winning issue among voters — a dynamic that helped Virginia Democrats make major gains in the state legislature in 2017, then break a GOP blockade and expand Medicaid while adding work requirements on the newly eligible.

Voters in Idaho, Nebraska and Utah will get to decide directly whether to accept the expansion.

And voters in Montana will be asked whether to keep its expansion intact beyond 2019, when the current policy would expire unless the legislature steps in.

A Kaiser Family Foundation poll from February found more than half (56 percent) of those in nonexpansion states think their governments should augment their programs, while 3 in 4 people nationwide had a favorable opinion of Medicaid overall.

"Ballot initiatives are a powerful tool because politicians in Washington are so out of touch with what voters actually want, which is more health care, not less," said Jonathan Schleifer, executive director of the Fairness Project, which spearheaded the petitions.

In Florida, expansion's prospects depend on the outcome of the governor's race, in which Mr. Gillum, Tallahassee's mayor, is running on a pro-Obamacare platform against Republican nominee Ron DeSantis.

After Texas, Florida has the most residents who stand to gain coverage from Medicaid expansion among holdout states.

"We had an opportunity to expand Medicaid for over 700,000 of the most medically needy people in this state, and we said 'no,' leaving $6 billion alone in last year's budget on the table," Mr. Gillum recently told NBC's "Meet the Press Daily."

Analysts said that even if he wins, he would have an uphill battle, since the GOP is likely to maintain control of both sides of the state legislature.

Joan Alker, executive director of the Center for Children and Families at Georgetown University, said a potential breakthrough "depends on how strong the blue wave is." She said the size of Democratic victories in Virginia helped convince a few key Republican senators to flip their stance.

The DeSantis campaign says expansion is a bad idea that would bust the state's budget, since states must pick up a share of the cost, reaching 10 percent starting in 2020.

"Ron DeSantis is focused on making health care more affordable for Floridians across our state by pursuing patient-centered, market-based solutions, while Andrew Gillum's massive Medicaid expansion would take money out of hard-working Floridians' pockets by raising taxes," said spokesman David Vazquez.