Medicaid expansion advocates are eyeing 2020 wins in red states by taking the issue straight to voters, a strategy that yielded success last year in other Republican-led states.
Proponents are petitioning Florida, Missouri and Oklahoma to include ballot measures asking residents if they want to broaden out the federal health care program to cover more low-income adults, many of whom are uninsured.
When the question was put to voters last year in three states where Republic governors had resisted ObamaCare's Medicaid expansion, the answer was “yes.”
But it’s a strategy rooted in desperation.
“This has become the tactic of last resort. The only way you’re going to break through the political gridlock that’s stopping Medicaid expansion now is to go through a ballot initiative,” said Patrick Willard with Families USA, a health care advocacy group that is advising advocates in Missouri and Florida.
“State advocates are looking up and saying, ‘We tried everything else, let’s go to a ballot initiative,' ” Willard said.
Under ObamaCare, states have the option to expand Medicaid to cover more low-income adults, with the federal government picking up most of the costs.
But 14 states — most with Republican governors or legislatures — have decided not to go down that road.
In recent years, expansion supporters have circumvented that opposition by making their case directly to voters, who approved initiatives in Utah, Nebraska and Idaho last year. That followed a 2017 success in Maine.
A key player in those victories was a D.C. based group called The Fairness Project, which has now become heavily involved with campaigns in Oklahoma and Florida — two states that have some of the highest rates of uninsured residents.
“Expanding Medicaid in Oklahoma will save lives, boost the economy, and keep rural hospitals open,” Jonathan Schleifer, executive director of The Fairness Project, said in a statement to The Hill. “It’s far past time to let voters decide this issue themselves.”
Oklahomans Decide Healthcare, the coalition of hospitals, nonprofits and other groups leading the ballot push, will on Wednesday begin collecting the 178,000 signatures it needs to land on the ballot.
The measure would amend the state’s constitution to expand Medicaid eligibility to low-income adults making less than $17,000 a year. That would impact about 200,000 people, according to the Kaiser Family Foundation.
The state is dealing with the fallout of an unprecedented number of hospital closures, partly because the state has the second-highest uninsured rate in the U.S.
“We can’t wait any longer, when rural hospitals have closed and more rural Oklahomans have to drive further to get the medical care we need,” said Amber England, the coalition’s campaign manager.
While the Fairness Project wouldn’t comment on efforts in Florida, where advocates have collected more than 80,000 signatures, financial records help paint a picture of its contributions.
The group has spent given more than $378,000 in in-kind contributions to Florida Decides Healthcare, the initiative’s campaign committee, on polling, petition collection and other expenses, according to state records.
But they still have a long way to go — 766,200 signatures will be needed before by the end of the year. The ballot question would ask voters if they want to approve a constitutional amendment making Medicaid available to adults up to age 65 who make less than $17,000 a year.
If the campaign is successful, it would be a significant win for Medicaid expansion advocates: Florida is one of the largest states that hasn’t expanded Medicaid, and has one of the highest uninsured rates in the country.
In all, 837,000 adults would become eligible for Medicaid should the state expand the program, according to the Kaiser Family Foundation.
Advocates in Missouri have also started collecting signatures for their petition to expand Medicaid to adults under 65 making less than $17,000.
A win there could make as many as 219,000 people eligible for Medicaid, according to the Kaiser Family Foundation.
“We’re excited about the potential for Medicaid expansion to deliver health care for hundreds-of-thousands of hardworking Missourians,” said Crystal Brigman Mahaney, communications director for Missouri Jobs with Justice, the group leading the effort at the state level.
But even if these initiatives can claim victory on Election Day, expansion isn’t necessarily a done deal.
When Maine voters approved Medicaid expansion by a 60-41 percent margin, then-Gov. Paul LePage (R) balked at implementation, arguing it would bankrupt the state.
Instead, it took a new Democratic governor two years later to follow through on expansion.
Similarly, GOP officials in Utah, Idaho and Nebraska are working on slimmed-down versions of Medicaid expansion that would offer fewer benefits and cover people.