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GOP Governors Rejected Medicaid Expansion, But Red State Voters Are Passing It Anyway

TOPLINE

Primary voters made Missouri the latest red state to pass an expansion of Medicaid eligibility under the Affordable Care Act – which could extend health coverage to over 200,000 low-income residents of the state – part of a string of electoral wins for the program in deep-red states even after it was roundly rejected by Republican governors.

KEY FACTS

Under the Affordable Care Act, passed by Democrats in 2010, states could choose whether to opt-in to the law’s Medicaid expansion, which provides health coverage to lower-income Americans.

But while many states chose to expand Medicaid between 2014 and 2016, 19 states  controlled by Republican governors refused to adopt the program.

Instead of pursuing expansion through a legislative route, advocates for the program have in recent years sponsored ballot initiatives to take the issue straight to voters – all of which have been successful thus far despite difficult partisan terrain.

The Fairness Project, a non-profit that promotes economic and social justice, has successfully led referendums to expand Medicaid in four deep red states – Idaho, Utah, Nebraska and Oklahoma – and Maine, a purple state whose Republican former governor rejected expansion three times.

On Tuesday, the Fairness Project notched another win with the passage of Medicaid in Missouri, a state that voted for Trump by nearly 20 points in 2016 but which backed expansion by a margin of 6 points, according to the New York Times.

Key Background

The Affordable Care Act has gradually risen in popularity since it was passed, and particularly since President Obama left office in 2017. An ill-fated attempt by Trump and Congressional Republicans to repeal the law that year was met with harsh public backlash and is widely seen as having precipitated a Democratic wave election in 2018 that led to the party’s takeover of the House.

Big Number

75%. Medicaid enjoys even broader popularity among the American public. A Kaiser Family Foundation poll in July 2019 found that 75% of  Americans have a favorable view of the program, including 65% of Republicans. An Economist/YouGov poll in June found that 90% of voters rate health care as an important issue – with 65% saying it is “very important” – amid the ongoing coronavirus pandemic.

What To Watch For

There are twelve remaining states that have not passed Medicaid expansions. Of those, four have public referendum processes: Mississippi, South Dakota, Florida and Wyoming. All but Mississippi have ongoing efforts to get Medicaid expansion on the ballot in 2020 or 2022, according to the Kaiser Family Foundation.

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