Obamacare on the Ballot: Will Red-State Voters Expand Medicaid This Fall?

People feel strongly about this.
Photo: Bill Clark/CQ-Roll Call,Inc.

Six years ago, John Roberts and four liberal justices upheld the Affordable Care Act as constitutional, in a dramatic Supreme Court ruling that saved the law from one of its many brushes with death. But, in its infinite wisdom, the court also ruled that states were not legally obligated to expand Medicaid, the portion of the law that expanded coverage for poor Americans to those who make up to 138 percent of federal poverty-level income — about $16,000 a year for a single person and $33,000 for a family of four.

So, to make it worth states’ while, the Obama administration put together an offer it figured would be difficult for them to refuse: the federal government would cover the entire cost of the expansion for the first three years of Obamacare’s existence, with states shouldering an increasing but still miniscule portion of the burden thereafter — only 10 percent starting in 2020.

And yet, plenty of states did refuse. The ones that opted out tended to have something in common beyond their hardheadedness: Republican governors and state legislatures who wanted no part of cooperating with a law that was anathema to their party’s base. (To be fair, Republicans’ natural revulsion to government-assisted health care likely also played a role in their defiance.)

In the meantime, Medicaid expansion proved to be the biggest success story of the Affordable Care Act. It has covered at least 15 million people, whose financial health care burden has been greatly reduced. A growing body of evidence shows that both access to health care and the quality of that care improved measurably in places that expanded the program, while the damaging financial repercussions its detractors feared — or claimed to fear — failed to materialize.