* Medicaid expansion is a central tenet of President
* Only one state,
* It is the first time voters will directly weigh in on provisions of the ACA since Congressional Republicans tried to repeal it.
It started with
It hasn't been smooth sailing.
But the passage alone galvanized health care advocates who wish to see Medicaid expansion in the 14 states that have declined federal money to offer health insurance to the people who fall in a "coverage gap," where they make too much money to qualify for Medicaid but can't afford private insurance.
In November, four states are voting on the issue --
Supporters of Medicaid expansion see it as a vital part of the social safety net, especially because qualifying for Medicaid in nonexpansion states can be tough. Opponents, however, see expansion as fiscally irresponsible since states will start picking up 10 percent of the costs in 2020.
While the price tag of Medicaid expansion can come with some sticker shock, independent analyses have found that states often save money by insuring people -- there are fewer instances of uncompensated care, and people are healthier when they have insurance. According to a 2016 report from the
While the federal government initially pays 100 percent of the costs of Medicaid expansion, it eventually hands states a bill for 10 percent. The funding issue is what LePage has been using as a reason to refuse to implement Medicaid expansion in
"Proponents insist that it'll pay for itself, but entitlement programs are historically costlier than anticipated. I imagine there are going to be some really tough discussions if it passes," says
"We modeled our language based on the
"That's honestly the best I could hope for," says Morfeld.
The ballot measure, meanwhile, asks voters to expand Medicaid traditionally -- without work requirements or eligibility limits past the federal poverty line. It also asks voters to increase the sales tax to fund the state's share. It's unclear what would happen if the ballot measure passes and the federal government approves
In three of the four states --
"There's been a lot of discussion in
For a summary of November's most important ballot measures, click here.
Visit Governing at www.governing.com
Distributed by Tribune Content Agency, LLC.