December 17, 2019


How Medicaid Expansion Is Transforming Politics As We Know It: Even in deep-red states, voters vigorously defend the program--and they know which party is attacking it. (Bryce Covert, 12/17/19, The Nation)

In the 37 states that have decided to take part, Medicaid coverage is open to everyone living at or below 138 percent of the federal poverty line. By March of 2018, nearly 672,000 more people were enrolled in Kentucky's Medicaid program and Children's Health Insurance Program than in 2013, most of them thanks to the expansion--a more than 110 percent increase. That's 15 percent of the state's population, including close to a fifth of the voting-age population. "If you don't have Medicaid yourself, you're interacting with people covered by Medicaid every single day," said Emily Beauregard, the executive director of Kentucky Voices for Health. By 2017, the state's uninsured rate dropped from 20 percent to 7.5 percent, the largest decrease in the country.

Those enormous gains make the deep-red state of Kentucky a particularly powerful example of an unexpected outcome: Beyond improving people's health and finances, the Medicaid expansion is changing how they view politics and their government. It's prompting them to get out and vote, and it has become a winning issue for Democrats, even in heavily Republican areas. And it could be transforming the way Americans view publicly funded health insurance itself.

Kentucky's Medicaid expansion means that more than a quarter of the state's population now gets coverage through the program. But just a year after its implementation, Republican Matt Bevin ran for governor promising to end the Medicaid expansion completely. "The fact that we have one out of four people in this state on Medicaid is unsustainable. It's unaffordable," he said on the campaign trail. "And we need to create jobs in this state, not more government programs to cover people." He won with 49.2 percent of the vote. After taking office, he sought a waiver from the federal government to allow him to impose a work requirement on Medicaid recipients, require monthly premiums, and eliminate retroactive eligibility, among other punitive changes. A judge struck down the waiver, but Bevin signed an executive order that would reverse the entire expansion if he didn't get his way in court.

Even so, he never carried out his threat. "There has not been one serious bill filed to end the Medicaid expansion," Beauregard said. "There was the sense that it wasn't a winning issue to take coverage away from people."

Now Bevin's efforts appear doomed. Six years after the expansion, Medicaid played a huge role in this year's gubernatorial contest between Bevin and Democrat Andy Beshear, the former governor's son. "Medicaid expansion and health care were front and center in the campaign," Beauregard noted. For Beshear, "it was a platform issue": He not only supported the Medicaid expansion but also repeatedly asserted that health care is a human right.

Voters paid attention. In a survey conducted by Beauregard's organization, many of those who said they cared about the issue were not enrolled in Medicaid themselves; they were just "concerned citizens who understood this was an economic issue, a social justice issue, an issue of neighbors taking care of neighbors," Beauregard said. "It was really striking to read so many comments from people who were not going to be directly affected and who could just as easily say, 'I'm the taxpayer footing the bill.' But instead they recognized there was value in their neighbors and coworkers having access to health care coverage."

Posted by at December 17, 2019 12:00 AM