2018 Election Review: Medicaid Expansion Ballot Measures

Last week, voters in three deep red states approved ballot measures to expand their state’s Medicaid program. Ballot measures in Idaho, Nebraska, and Utah all received comfortable margins of approval while voters rejected Montana’s I-185, which would have funded a continuation of the state’s expanded Medicaid program by taxing tobacco products.

In addition to wins via ballot measure, Medicaid expansion supporters received good news in two states’ governor's races.

Maine’s governor-elect Janet Mills (D) vows to implement Medicaid expansion as soon as she takes office after the LePage Administration delayed implementation following a voter-approved ballot initiative in 2017. Governor-elect Laura Kelly in Kansas includes Medicaid expansion as a top priority of her new administration. Last year, the Republican-controlled legislature passed legislation to expand Kansas’ Medicaid program, however, then-governor Sam Brownback (R) vetoed the bill.

And earlier this year, Virginia expanded its program after years of resistance from the Republican-controlled General Assembly.

Since the Affordable Care Act (ACA) was enacted in 2010, 36 states and the District of Columbia have chosen to expand their programs for residents earning up to 138 percent of the federal poverty level (FPL). In 2013, Arkansas became the first state to expand Medicaid under an alternative method (utilizing a federal 1115 waiver) and now eight of the 33 expansion states have chosen that path.

Idaho Proposition 2: Medicaid Expansion Initiative
Passed
More than 60 percent of Idahoans approved Proposition 2, thereby expanding Medicaid coverage for those earning up to 133 percent of the FPL or below and who are not eligible for other state insurance coverage. Idaho Governor Butch Otter (R) and certain Republican state lawmakers supported the effort to expand coverage to cover childless and low-income adults.

Montana I-185: Extend Medicaid Expansion and Increase Tobacco Taxes Initiative
Failed
In one of the most expensive ballot measure campaigns in the state’s history, Montana voters rejected I-185, leaving the state’s already expanded Medicaid program without dedicated funding. Polls leading up to election day even showed that this measure would come down to the wire. Tobacco companies lobbied hard against the measure since it would have placed a $2 per-pack tax on cigarettes. State lawmakers will now need to find a funding source during the 2019 legislative session if they want to continue the program.

Nebraska Initiative 427: Medicaid Expansion Initiative
Passed
Nebraska voters approved Initiative 427 to expand Medicaid for persons under the age of 65 and with incomes equal to or below 138 percent of the FPL. It is unclear how Governor Pete Ricketts (R) and many state legislators who opposed the adoption of the initiative will pay for the expansion.

Utah Proposition 3: Medicaid Expansion Initiative
Passed
After Utah Governor Gary Herbert (R) signed a partial Medicaid expansion bill (UT HB 472) back in March, nearly 54 percent of voters approved extending Medicaid expansion. Utah Decides Healthcare led the charge in placing Medicaid expansion on the ballot as well as garnering enough support for the measure on election day.