Maine’s voters look like they are about to authorize a Medicaid expansion.
Medicaid expansion is turning into a rout. https://t.co/MmS3OiUJMM pic.twitter.com/xaAfb2DYDH
— Portland PressHerald (@PressHerald) November 8, 2017
The Congressional Budget Office throughout 2017 analyzed Republican Repeal bills. They consistently estimated that several million people would have lost coverage by the end of the projection window because they lived in states that had not yet expanded Medicaid but would have expanded Medicaid at some point.
This makes sense. We knew that Maine was continually trying to pass Medicaid Expansion only to see it vetoed. We saw Virginia’s Democratic governor try to accept Expansion. We saw Kansas approve expansion and only see it vetoed. We are seeing Idaho doing back-flips to not expand Medicaid while expanding coverage for tens of thousands of people who make under 100% FPL (<$12,060 for a single individual). Oklahoma has a complex waiver plan to cover everyone under 100% FPL as well. There is a desire by states to have the federal government pay to cover the healthcare costs of more of their citizens. I could see quibbles about how many states that have not expanded will expand and how fast, but the core assumption makes sense to me. It did not make sense to the Apothecary’s Josh Archambault:
But a cursory look at the CBO’s own data raises serious questions about its headline conclusion and should make many in Congress ask CBO some tough questions.
CBO’s projected Medicaid losses have their own problems. For example, 5 million are projected to “lose” Medicaid expansion coverage in states that never expanded Medicaid in the first place….
AEI’s Joel Zinberg made a similar attack on the CBO assumption that Medicaid Expansion would continue:
The CBO predicts the AHCA will decrease Medicaid by 4 million by 2018, 9 million by 2020, and 14 million by 2026. It estimates 5 million of this loss will come from, “… people who CBO projects would, under current law, become eligible in the future as additional states adopted the ACA’s option to expand eligibility.” But there is little evidence that the 19 states which have thus far not expanded eligibility under the ACA would choose to do so in the future, particularly since under the ACA states will now have to start sharing some of financial burden for these newly eligible enrollees with the federal government.
Maine is a demonstration case that states will continue to expand. Kentucky is a demonstration case that Expansion so far is a one-way ratchet. A 9:1 match with the ability to shift some state costs to the Feds is an attractive offer. It is reasonable to assume that more states will take it up.
Anonymous At Work
Maine hasn’t expanded yet; never underestimate LePage’s ability to be an asshole.
MomSense
Maine’s recent Medicaid history is a bit more complicated. In 2003 MaineCare already covered pregnant women, infants, and children up to 200% FPL. Working parents were at 157% and the Aged Blind Disabled (ABD) were at 100%.
As part of Dirigo health, in 2004 we got the non categorical adult waiver approved insuring about 25,000 childless adults. Then in 2005 we expanded coverage for working parents from 150% to 200% and for the disabled it went from 100% to 125%.
What LePage and the GOP actually did was to contract MaineCare eligibility dramatically so individuals and families who had health care through Medicaid lost it. I think it was about $90,000 people.
I don’t think it was widely understood just how big a fuck you it was to the working poor in Maine.
ETA LePage and the GOP also blamed it on ObamaCare in really weaselly letters they sent out telling people they lost their coverage.
Ohio Mom
On another note, Ohio’s issue on reining in drug prices went down. I voted for it, despite some misgivings about what implementing it would entail. Mostly I wanted to send a message to big pharma. Which considering the final vote count, they will not receive.
JanieM
@Anonymous At Work:
Zebra, stripes.
Zach
It blows my mind that Trump’s too dumb to own this, say “now it’s time for Trumpcare!” and claim credit for all post-Obama medicaid expansion. It’s gonna happen anyway, it’d give cover to GOP governors and legislatures that need it to keep local taxes low on the rich, etc. Paul Ryan types who wanna dismantle all anti-poverty spending would be sorta angry but really they don’t care all that much and would go along with it if it increasing Trump/GOP approval enough to get tax cuts passed and keep Republicans in office to dismantle the regulatory state and control the courts.
Fake Irishman
Arkansas is another example as Medicaid expansion as a one-way rachet.
Amir Khalid
@Zach:
Does Trump really have that option? He’s staked his political fortunes, and his shrivelled little heart, on killing Obamacare just to spite Obama. If he loses, he loses also the support of his party. The Bazilllionaire Donor Class to whom Republican Congressfolk answer want it dead ASAP; If the R Congressfolk start taking credit for Obamacare’s successes, instead of inveighing against it or straining mightily to repeal it, Mammon the God of Billionaires shall be displeased and smite their campaign funds right in the bank balance.
Zach
He can say he both destroyed Obamacare (by undermining subsidies and/or repealing the taxes that pay for them) AND say his wonderful “Trumpcare” came in to save the day by giving healthcare to the poor people who vote for him in red states.
9.4M people receive Obamacare subsidies; a lot of them will vote for Democrats or Republicans no matter what happens to the subsidy. They’re distributed throughout the country. In many of their minds, Obama will be blamed if Obamacare fails. I’d guess that if the Obamacare subsidies fail it won’t move the needle much, politically (even though it’ll be a disaster for some left without affordable healthcare options).
There’s ~2.4M people in the medicaid coverage gap (too rich for medicaid without expansion; too poor for Obamacare subsidies). There’s another 1.6M who’d switch to Medicaid from Obamacare after the expansion. Over half are in TX/FL/GA/NC — pretty important with respect to elections. That’s 4M people who’d have Trump to thank for their health insurance if Trump takes credit.