Aug 4, 2017

Why 2018 could lead to more Medicaid expansion

It's never too early to start thinking about the upcoming 2018 elections. And while a lot of the focus so far has been on the House, a handful of hotly contested gubernatorial races could have higher stakes for health care — specifically, for the Affordable Care Act's Medicaid expansion.

A raft of open governors' races next year will give Democrats a chance to replace some of the most stridently anti-expansion governors in the country — and, if they win even a few of those races, the chance to cover millions of currently uninsured people even as the Trump administration drags its heels on so much of the ACA.

Data: Kaiser Family Foundation, The Cook Political Report; Note: Maine, a toss up state, was not included due to insufficient Medicaid data; Chart: Andrew Witherspoon / Axios
  • 15 non-expansion states will hold gubernatorial elections this year or in 2018. Ten of those will be open seats.
  • Democrats won't win all of those races. But several of their best political opportunities are in the states where Medicaid expansion would cover the most people.
  • One of the biggest battlegrounds: Florida, where Gov. Rick Scott will be term-limited next year. The Cook Political Report considers Florida a toss-up. And if Scott's successor is more amenable to the Medicaid expansion, nearly 800,000 Floridians could gain coverage, according to the Kaiser Family Foundation's estimates.
  • Maine Gov. Paul LePage — one of the ACA's loudest critics — is also leaving office, and one of the expansion's biggest defenders — Sen. Susan Collins — might run to replace him.
  • Virginia's state legislature has previously come up just a few votes shy of adopting the expansion, which would cover some 225,000 people.

Why it matters: There's not much the Trump administration could do to stop more states from signing on to the Medicaid expansion, especially if those states don't seek waivers from certain structural rules as part of the process. And that means Democrats, already energized by the health-care fight, have a real chance to build on the ACA's coverage gains, even under a hostile administration — if they can get their act together at the state level.

Go deeper

Health policy in 2020 will be made in the states

Illustration: Aïda Amer/Axios

With legislation in Congress likely to be blocked by partisan division and interest group opposition, much of the real action in health care this year will be in the states.

The big picture: States don’t have the money or purchasing power the federal government does, but their decisions nevertheless affect millions of people, and they could signal the future of federal reform.

Go deeperArrowJan 6, 2020

Study: Medicaid expansion helps improve infant mortality rates

A newborn baby in the intensive care unit. Photo: Anton Novoderezhkin\TASS via Getty Images

Medicaid expansion and other social services help improve infant mortality rates, according to a new report from the liberal Center for American Progress.

Why it matters: The U.S. is ranked 55th in the world on infant mortality — alongside Serbia.

Go deeperArrowDec 17, 2019

State and local officials fight to keep Medicaid for inmates

Angola prison in Louisiana. Photo: Giles Clarke/Getty Images

Some local and state officials want Medicaid to start picking up the tab for inmates' health care, Stateline reports.

How it works: Medicaid beneficiaries lose their coverage while they're incarcerated — including pretrial detention for people who can't make bail — and county governments are generally responsible for providing their care.

Go deeperArrowJan 9, 2020