Medicaid: The Winner of Election 2018

Last night was an amazing night in American politics, especially when it comes to health care. With the Democrats taking the House of Representatives and the Senate remaining in the hands of Republicans, Congress will be divided during its 2019-2020 session. This likely means that the Affordable Care Act, its Medicaid Expansion, and the structure of health entitlements will remain intact.

Let us recap a few things:

1. Voters in Utah, Nebraska, and Idaho elected to expand Medicaid. [see our 1-pager on that subject HERE]

2. Voters elected Governors in Maine, Kansas, and Wisconsin that are friendly toward Medicaid expansion.

3. Montana lost its bid to continue its Medicaid expansion by increasing the state cigarette tax by $2 per pack.

A great summary of last night’s wins can be found in a story by Sarah Kliff from Vox. Now, the Medicaid expansion map (left) will turn even more blue. The country will be left with 2 large pockets of states that haven’t expanded – the Deep South (TN, NC, SC, GA, FL, MS, AL) and the Great Plains. (WY, SD, KS, OK, TX) – as well as Missouri and Wisconsin.

Wyoming, South Dakota, and Oklahoma are states that allow for ballot initiatives like the ones we saw pass last night. However, those states overwhelmingly supported Republicans for governor and it would be wise to assume those states would be less amenable to Medicaid expansion. The remaining states either require legislative efforts or constitutional amendments to expand Medicaid. Thus, based on last night’s results, the best options to expand Medicaid going forward are Wisconsin and Kansas.

We should keep our ears open to the sounds of the grassroots in those two states to divine what may happen in the coming year or two. Hopefully, we will see more Americans earn the right to health care that those in 37 states and DC now enjoy.