In These Four Red States, Health Care is on the Ballot

Tomorrow, Americans will go to the polls to cast their votes for elected officials from the U.S. Congress to governors’ offices to state and local positions. Polling has consistently shown health care, and health care affordability, to be a top concern of voters heading towards Election Day.

In fact, in four traditionally Republican states — Utah, Nebraska, Idaho, and Montana — health care will be directly on the ballot. Voters in those states have a chance to weigh in on whether to extend access to affordable health care to more people in their states via ballot initiatives to implement or continue Medicaid expansion.

A bit of background: Under the Affordable Care Act, states could expand their Medicaid programs to cover lower income adults beginning in 2014. It was and is a good financial deal for states: the federal government covered 100% of the cost of the program for the first three years, ratcheting down to eventually covering 90% indefinitely, with states on the hook for the other 10%. Compare that to the federal contribution for traditional Medicaid, which differs state to state, but ranges from 50-76%, and many states saw the both the economic and moral value in expanding.

To date, 33 states and the District of Columbia have opted to expand. Expansion states have seen benefits in improved health outcomes, affordability for individuals, stability for rural hospitals, and boost to state economies and jobs. It has been touted by unlikely champions like Governor Kasich of Ohio, who credits the expansion for addressing the state’s opioid epidemic and allowing Ohio to leverage billions in federal funding.

In the remaining states that have not expanded, however, millions of Americans are caught in the “coverage gap” — making too much money to be eligible for traditional Medicaid in those states, but not enough to qualify for tax credits to help pay their premiums on the individual insurance marketplace.

I know well the difficult process that many Republican governors went through in deciding whether to support Medicaid expansion. During my eight years serving in the Obama administration at the Department of Health and Human Services, I spent much more time connecting with Republican governors and legislators than Democratic ones, often assisting them as they attempted to negotiate a path forward on expansion and other sticky health care issues. The truth is, we were able to find a lot of common ground when we set aside politics and dug into the underlying goals on both sides: covering more Americans with affordable health care. Sometimes we were able to forge a path with a state-specific model, as in Indiana (under then-Governor Mike Pence) and Michigan, while other well-intentioned efforts were thwarted by key leaders unwilling to come to the table for ideological reasons.

A lot has changed since then. Obamacare’s namesake is no longer in office, the electorate is activated around health care, and states are realizing they are leaving billions of dollars on the table that could go to providing care to their communities. Advocates in Utah, Idaho, and Nebraska — tired of waiting on state leaders to accept the overwhelming data on the benefits of Medicaid expansion — are taking the question directly to their fellow citizens. And in Montana, which implemented expansion in 2016 to positive results, the ballot initiative allows citizens to bypass legislators to continue the program past its expiration next year.

At United States of Care, we believe there is more that unites Americans around health care than what divides us — and certainly more than what current partisan politics would have us believe. We are encouraged by bipartisan support for the expansion effort in Idaho, where the initiative has been endorsed by Republican Governor Butch Otter and is co-chaired by a Republican legislator, and Utah, where polling shows nearly two-thirds of voters surveyed support expansion, including nearly half of Republican respondents.

We have every reason to believe that this bipartisanship will continue after the votes are counted and elected officials are tasked with implementing the will of their constituents. Both candidates for Governor in Idaho have publicly pledged to do just that — along with an impressive number of Republican legislators. We hope this becomes the standard, rather than the example of Maine, where ideological resistance has delayed implementation of the law passed decisively by the state’s voters in 2017. With mandates directly from voters, this common sense policy should become even easier for officials from all political persuasions to embrace.

We’ll be watching closely how voters in Nebraska, Montana, Idaho, and Utah weigh in, and how their elected leaders respond. We believe the results will demonstrate that when you strip away political labels, and ask Americans directly, they just want to be able to take care of themselves and their families; to afford the care they need without worrying about facing financial hardship; and to make sure their friends and neighbors can do the same.