It's Election Day — and there's a lot at stake for the Affordable Care Act's Medicaid expansion.
Voters in Maine will have a chance to weigh in directly, via a first-in-the-nation ballot initiative on whether to expand Medicaid. It stands a good chance of passing — but even if it does, an actual Medicaid expansion in the state could be more than a year away.
- The state legislature has already voted six times to expand Medicaid; Gov. Paul LePage has vetoed each one. Today's referendum was initially seen as a way to work around LePage's steadfast opposition.
- But even if today's referendum passes, LePage's administration may well drag its feet until the governor is term-limited out of office next year, according to Mitchell Stein, a Maine consumer advocate who supports expansion. LePage's successor would then have to implement the expansion.
- The symbolism of a win would still be significant. National advocacy groups are looking for a victory in Maine to help set the stage for similar ballot initiatives in other non-expansion states. And it'd be a morale boost for the ACA's advocates, at a time when the law is under attack. "There are positives on an emotional level," Stein told me.
Medicaid expansion is also in the balance in Virginia. Outgoing Gov. Terry McAuliffe tried to expand the program, but was rebuffed by Republicans in the state legislature. But Democrats have a good shot at picking up seats in the statehouse — if they pick up enough, Medicaid expansion could advance in Virginia even before it does in Maine.
Why it matters: The ACA's Medicaid expansion would cover an estimated 400,000 people in Virginia and 80,000 people in Maine.
Go deeper: The Trump administration isn't doing much to boost enrollment in the ACA's exchanges, but a raft of open governors' races next year present an opening for millions more people to gain Medicaid coverage — making the law's repeal even more politically difficult.