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Medicaid expansion gets extra boost from governor races

Medicaid expansion gets extra boost from governor races

Medicaid expansion advocates are looking to capitalize off their midterm victories by potentially adding Kansas and Wisconsin to their list of recent wins.

Voters in three deep-red states voted to extend coverage to low-income adults, and those wins could spur expansion efforts next year in Wisconsin and Kansas, where Democratic candidates won governor's races on Tuesday.

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“I think the midterms were great news on Medicaid and expansion,” said Patti Boozang, a consultant with Manatt Health. “It’s validation that people really want expansion in their state.”

Boozang said lawmakers in non-expansion states are going to be hard-pressed to hold out in the future.

“There’s a lot of evidence that it works and it does a lot of really good things for states,” she said. “The growing evidence base on expansion is increasingly hard to ignore.”

Before the 2018 midterm elections, 33 states and the District of Columbia had expanded Medicaid to people earning up to 138 percent of the federal poverty level. The U.S. government will pay for most of the cost; about 94 percent this year and gradually sliding to 90 percent by 2020.

Utah, Nebraska and Idaho voters on Tuesday approved ballot initiatives in their states that would expand Medicaid eligibility to 325,000 residents.

That momentum could aid Kansas Gov.-elect Laura Kelly (D) and Wisconsin Gov.-elect Tony Evers (D), who vowed in their campaigns to expand Medicaid coverage. But they both could face stiff headwinds from their legislatures.

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“We think it’s really noteworthy that in the elections this week, three more states have adopted expansion,” said April Holman, executive director of the Alliance for a Healthy Kansas, which leads expansion efforts in the state.

“Nebraska to our north and Colorado to our west has expansion,” she said Thursday. “We really think the time has come for Kansas to join this movement.”

Kelly, who will succeed Kansas Gov. Jeff Colyer (R) in January, told local reporters Friday she hopes to pass a bipartisan expansion plan before the legislature adjourns in the spring. The legislature approved Medicaid expansion last year, but it was vetoed by then-Gov. Sam Brownback (R).

Holman said she’s hopeful that a supportive governor means expansion can get done next year, even though Democrats lost a few House seats in the state legislature on Tuesday.

“We think if we can get it to a vote in the House and Senate, we would have the majority to pass expansion,” Holman said.

But GOP opposition to Medicaid expansion isn’t disappearing. Newly elected Democratic governors are likely to have to fight Republican-dominated state legislatures.

In Kansas, the expansion bill had hearings this year but did not advance to floor debate.

Wisconsin advocates say Evers is in for more of a fight than Democratic governors in other states, in large part because of a GOP-controlled Senate and Assembly.

Robert Kraig, executive director of the progressive group Citizen Action of Wisconsin, said State Assembly Speaker Robin Vos (R) “has declared expansion will not happen.”

“They have come out very aggressively,” Kraig said.

Shortly after incumbent GOP Gov. Scott Walker conceded the race to Evers, Vos poured cold water on any prospects of bipartisan cooperation.

“While yesterday was a win for Governor-elect Evers, it cannot be seen as any kind of mandate for change,” Vos said in a statement. “Assembly Republicans will continue to deliver on our conservative promises to our constituents and won’t allow Wisconsin to slide backward.”

In October, Vos was adamant that he would not allow Medicaid expansion in the state.

"Not going to happen. No way. Never," Vos told reporters, according to the Milwaukee Journal Sentinel.

But Evers has leverage on the issue and can tie the extra money that will be saved through expansion to other popular priorities, like increased spending on education, according to Craig.

“He puts Republicans in a difficult bind if it has good things the state can do with the additional money,” Kraig said.

Funding fights are also likely in Idaho and Nebraska.

The measures in those states didn’t stipulate how expansion would be funded, so their state legislatures will have to pass a spending bill when they reconvene in January.

That could create tension between lawmakers who disagree on how to pay for expansion.

In Nebraska, Gov. Pete Ricketts (R) promised to follow the will of the people and implement expansion, even though he campaigned against it.

However, Ricketts told The Associated Press that he would oppose any effort to pay for the expansion through tax increases.

In Idaho, outgoing Gov. Butch Otter (R) endorsed the Medicaid initiative shortly before Election Day, and Republican Gov.-elect Brad Little said he would implement it, though he hasn’t suggested any funding options. The ballot language said expansion must be implemented within 90 days of election certification.

"I am committed, as I told everybody, if this passes we have got to implement Medicaid expansion, but we have got to do it the right way where it works for Idaho," Little said in an interview after the election with local TV news channel 7KTVB.

Expansion supporters in Idaho and Nebraska are hopeful they’ll avoid a repeat of what happened in Maine last year, when Gov. Paul LePage (R) refused to implement expansion despite voters approving it.

Advocates took LePage to court, and the lawsuit is still pending.

But Maine’s Gov.-elect Janet Mills (D) said she’ll implement Medicaid expansion on Day One when she assumes office in January.