Voters in three deep-red states went around their elected representatives to approve Medicaid expansion at the ballot box Tuesday.
Idaho, Nebraska and Utah residents all supported measures that extend Medicaid to residents with incomes up to 138% of the federal poverty line.
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The grassroots efforts will provide coverage to hundreds of thousands of people and could take effect as early as the spring.
Democratic victories in several gubernatorial races also raise the likelihood of Medicaid expansion in additional states.
Maine's newly elected Democratic governor Janet Mills is expected to push through Medicaid expansion that was approved last year by voters in a first-of-its-kind ballot measure that was blocked by outgoing Republican Gov. Paul LePage. Mills will have the support of both state houses since Democrats also won control of Maine's Senate.
Voters in Kansas, meanwhile, elected Democratic candidate Laura Kelly, who has promised to support and sign an expansion bill next year. The Republican-controlled legislature approved broadening Medicaid there last year, but the bill was vetoed by then-Gov. Sam Brownback.
And in Wisconsin, newly elected Democratic Governor Tony Evers may try to fully expand Medicaid, though he would face a tough battle with the Republican-controlled state legislature. The Badger State partially broadened Medicaid to cover those up to the poverty line and also recently received federal approval to impose work requirements and premiums on enrollees.
"Last night made clear that expanding access to health care isn't a blue state value or a red state value ... it's an American value," said Jonathan Schleifer, executive director of The Fairness Project, which supported the ballot initiatives. "Voters have sent an unambiguous message that they want more health care, not less."
With four victories under its belt, the Fairness Project is now looking at where else it can put Medicaid expansion before the voters. Among the options are Florida, Oklahoma and Mississippi, Schleifer said.
Some 31 states plus the District of Columbia have already expanded Medicaid, an Obamacare provision that broadens coverage to Americans with incomes up to 138% of the poverty level, or about $17,000 for an individual and $35,000 for a family of four. Virginia will join the club in 2019, after lawmakers there approved the expansion earlier this year. The federal government covers at least 90% of the cost.
One Medicaid ballot initiative, however, looks headed for defeat. Montana voters appear to be giving the thumbs down to continuing to fund Medicaid expansion by raising tobacco taxes to help pay the state share. Expansion is set to end in Montana next summer.