The votes are in: Medicaid has strong public support

By Suzanne Wikle

Once again, Medicaid is the week’s hot topic. On the one hand, the Trump Administration is taking action to reduce access to Medicaid for low-income workers, while on the other hand, voters are saying loud and clear they support increasing access to Medicaid for low-income workers. 

Seema Verma, who leads the Centers for Medicare and Medicaid Services (CMS), stated earlier this week that CMS will, for the first time, approve states’ requests to implement a work requirement for Medicaid. Our recent FAQ on this topic explores all the reasons why work requirements are a bad idea for Medicaid, but the bottom line is that they create red tape and bureaucracy, don’t actually lead to strong employment outcomes, and end up causing many eligible people to lose their health care.

Contrary to recent actions and statements by CMS, voters demonstrated on Tuesday that Medicaid is a valuable support system that should be available to more people. Maine voters overwhelming passed—by a 59 percent to 41 percent vote—a ballot initiative to expand Medicaid. The expansion is estimated to provide health insurance to approximately 70,000 Mainers who earn too little to qualify for tax credits to purchase private insurance and current fall into the “coverage gap” with no affordable health insurance options. With Tuesday’s vote Maine becomes the 33rd state (including DC) to expand Medicaid as intended by the Affordable Care Act (ACA). Once implemented, Mainers with incomes up to 138 percent of the poverty level ($16,642 for an individual and $28,179 for a family of three) will be eligible for Medicaid.

In Virginia, several House of Delegates candidates included Medicaid expansion in their platforms and beat out incumbents and others opposing expansion. Likewise, Dr. Ralph Northam, who was resoundingly elected Virginia’s next governor, ran in large part on expanding Medicaid. The message is clear: the public supports Medicaid and wants the program to be a true safety-net for low-income families and workers who simply can’t afford the cost of private insurance.

After several successful fights over the summer to keep Congress from significantly changing Medicaid, it’s more clear than ever that Medicaid will continue to be under attack by Trump-appointed administrators. In fact, this week the CMS website was updated to change the criteria for how Section 1115 waivers to the Medicaid program would be evaluated. As you can see in the pictures below, the new language doesn’t state that waivers will be measured against whether they increase and strengthen coverage for low-income persons or improve health outcomes. Rather, the new language includes code language for work requirements and other burdens, such as “incentive structures” and “strengthen[ing] beneficiary engagement.” 

The previous criteria for how Section 1115 waivers to the Medicaid program would be evaluated.


The new criteria for how Section 1115 waivers to the Medicaid program would be evaluated.

The announcement this week to begin allowing work requirements is only the beginning of what CMS may do in the coming months to undermine Medicaid. Yet it’s clear from election results and other polls that the public wants improved access to health care, not the kind of attacks we are seeing from the Trump Administration.