Healthcare

Health advocates sense momentum on Medicaid expansion

Virginia's expansion of Medicaid this week is giving hope to advocates in other states.

After Virginia overcame years of Republican opposition to pass the expansion under ObamaCare, supporters are giving renewed attention to what could be the next states to expand: Utah and Idaho, where initiatives are set to be on the ballot this November.

Activists in Nebraska are also gathering signatures and say they are on track to get the issue on the ballot there.

The subject will loom large in governors' races as well, most notably in Florida, one of the largest states that has not expanded the program giving health insurance to the poor.

Opponents argue Medicaid expansion will lead to runaway spending. Virginia's Republican state Senate majority leader, Tommy Norment, denounced the state's move on Wednesday, saying it "abandons Virginia's long-standing reputation for fiscal responsibility." 

But backers sense that the politics have shifted on the issue. With former President Obama out of office and ObamaCare repeal efforts seemingly dead in Congress, there could be less resistance to accepting changes as part of the health-care law.

"Some states have been missing out on Medicaid expansion simply because of partisan politics," said Patrick Willard, a senior director at the liberal advocacy group Families USA. "There's an opening now there, as Virginia showed, to work towards a compromise rather than to just think of it as an Obama-era [issue]."

Virginia Del. Terry Kilgore, one of the first Republicans in the state legislature to come out for Medicaid expansion, told The Washington Post in March that the backlash to his position had been smaller than expected, despite the conservative group Americans for Prosperity running ads broadcasting his office phone number.

"No calls, no comments," Kilgore said.

"What I've heard people say is, 'Hey, what you said made sense. We don't mind helping people if they're helping themselves,' " he added.

Democrats are seizing on the momentum in campaigns. Sen. Bill Nelson (D-Fla.) this week blasted his opponent, Gov. Rick Scott (R), for not expanding Medicaid while governor.

"Why didn't they do it? Well, I'll tell you exactly why. It was Gov. Scott," Nelson said.

"People here looked at what happened in Virginia and think that Florida's next. It's a winning issue for us," said Kevin Donohoe, a spokesman for the Florida Democratic Party. Multiple Florida Democratic candidates for governor highlighted the news from Virginia, and Donohoe said the party is planning events around the state pushing for Medicaid expansion.

"Today, the Virginia Senate voted to expand Medicaid - a victory that will transform hundreds of thousands of lives," tweeted Democrat Stacey Abrams, who is hoping for an upset win to become governor of Georgia. "Medicaid expansion will be my Day One priority."

The more immediate opportunities, however, are referendums in Utah and Idaho.

"It has a good shot," said Chris Karpowitz, co-director of the Center for the Study of Elections and Democracy at Brigham Young University in Utah.

A poll from The Salt Lake Tribune and University of Utah in February found that 62 percent of Utah voters support expanding Medicaid.

"It's been notable just how supportive the public has been of this issue across multiple polls and multiple years," Karpowitz said. "That's pretty notable for a deep-red state."

He said what could potentially derail the bid is if there is strong organized opposition that highlights the cost to the state, which could make voters wary.

It is unclear how strong opposition will be. RyLee Curtis, the campaign director for Utah Decides Healthcare, a group backing the initiative, noted that there was no organized opposition challenging the signatures that her group submitted to get on the ballot.

Another factor is former GOP presidential nominee Mitt Romney, who is running for Senate in the state.

"If Romney were to come out strongly against that could be a factor, although I don't expect him to do that," Karpowitz said.

A spokeswoman for Romney's Senate campaign declined to comment on his position on the Medicaid expansion initiative in the state, though he supported similar reforms while governor of Massachusetts.

Americans for Prosperity, which is backed by conservative billionaires Charles and David Koch, is planning to keep working against Medicaid expansion, though it said it is too early to know whether it will run ads in Utah and Idaho.

Akash Chougule, director of policy for the conservative group, said it will "by all means continue to be engaged" against Medicaid expansion efforts.

He acknowledged the Virginia result was "definitely disappointing given how long conservatives have been able to stop Medicaid expansion," which he said would be a "budget-buster."

In Idaho, activists traveled the state in a van gathering signatures for the ballot initiative, and they said they have passed the 56,000 needed.

A 2016 poll from Dan Jones & Associates found 64 percent of Idahoans disagreed with the legislature's decision not to expand Medicaid.

ObamaCare expanded Medicaid eligibility up to 138 percent of the poverty line, which is about $35,000 for a family of four. Seventeen states, though, have so far declined to accept the expansion, largely due to opposition to ObamaCare as a whole and budgetary concerns.

The decline of the Republican repeal push in Congress, however, could play a role in convincing some of the remaining states to expand.

Karpowitz said it was "helpful," that "the debate about whether to repeal ObamaCare seems to have faded into the background a little bit."

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