Expanding Medicaid through the Voting Booth

By Renato Rocha

The benefits of expanding Medicaid are clear: Greater financial security for those gaining health coverage, fewer uninsured patients for hospitals to treat, and projected net fiscal gains for states. Rather than ignore or try to undermine these benefits as many governors, Republicans in Congress, and the Trump Administration have done, advocates in several states are taking it upon themselves to expand Medicaid through November ballot initiatives.

Medicaid expansion ballot measures being championed in Utah, Idaho, and Nebraska would provide health coverage for people who fall into the coverage gap, meaning they make too much to qualify for Medicaid, but not enough to get subsidized health insurance through their state’s ACA insurance marketplace.

We have summarized the current status of these ballot initiatives and used a new report from the Robert Wood Johnson Foundation and Urban Institute to estimate the benefits of Medicaid expansion in the three states. 

  •  Utah: Supporters of the Medicaid expansion measure needed to collect more than 113,000 signatures to put the initiative on the ballot. Before the April 15 deadline, proponents of the measure collected and submitted 165,000 signatures, well above the state’s threshold. If voters approve the Medicaid expansion initiative in Utah, an estimated 76,000 more people would get health coverage and the state’s uninsured rate would drop by approximately 20 percent.
  • Idaho: Proponents of the initiative collected more than 60,000 signatures by April’s deadline, considerably more than the 56,192 signatures required for ballot measures. If Idaho voters approve the measure, an estimated 69,000 more people would get health coverage and the state’s uninsured rate would drop by approximately 32 percent.
  • Nebraska: Supporters of the Medicaid expansion measure have until July 6 to submit approximately 85,000 required signatures. If the measure makes it on the ballot and voters approve it, an estimated 45,000 more Nebraskans would get health coverage and the state’s uninsured rate would drop by approximately 23 percent.

Last November, Maine became the first state to pass a ballot initiative to expand Medicaid, doing so with overwhelming voter support (59 percent to 41 percent). Since then, however, Governor LePage has refused to follow the law and expand Medicaid. If Governor LePage obeys the will of Mainers, the state can expect an estimated 34,000 more people enrolled in health coverage and a drop of about 23 percent in its uninsured rate. Undeterred advocates are now taking the fight from the ballot box to the courtroom, suing Governor LePage to force him to implement the ballot initiative.

Fortunately, advocates in all these pioneering states have both the support of voters and overwhelming evidence on the benefits of Medicaid expansion. For the 14 states that have not yet expanded Medicaid, it’s far past time to expand health care coverage—whether through gubernatorial action, legislation, or ballot initiatives.