Ballot Revolt to Bring Medicaid Expansion to Trump Country
Oct 20, 2018 21:25:18 GMT -5
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Post by Jessiealan on Oct 20, 2018 21:25:18 GMT -5
SANDPOINT, Idaho — One month before Election Day, about 30 volunteers packed into a home in this northern Idaho town in the heart of Trump country, preparing to knock on doors to build support for a ballot measure to adopt Obamacare’s Medicaid expansion.
Luke Mayville, an Idaho native who’s helping to lead the effort to bring more health care to lower income people in his home state, gave a blunt assessment to the activists: “It’s a tragedy if we lose,” he said. “If we win, we make history.”
Next month, voters in two other conservative states, Utah and Nebraska, will also decide on Medicaid expansion, and polling suggests they have a good chance of passing. Montana will also vote on keeping its program. Maine voters last year were the first to approve Medicaid expansion through the ballot, although Republican Gov. Paul LePage has done everything possible to block expansion in his final year in office. A few other holdout states — most notably Georgia, Florida and Wisconsin — would also become much more likely to embrace Medicaid expansion if Democrats prevail in gubernatorial contests next month.
If successful, this year’s ballot measures would mark the most significant growth of Medicaid expansion since the early phase of the Affordable Care Act — and a resounding rebuke to GOP lawmakers in states that have rejected a program that’s financed mostly with federal dollars. It would also come as the Trump administration tries to shrink Medicaid and Republican lawmakers in Washington hope to take another crack at Obamacare repeal, perhaps as early as the lame-duck session of Congress after the midterm elections.
Idaho is arguably some of the least fertile ground in the country to cultivate a grassroots campaign to massively expand government-backed health care. Republicans dominate the state’s politics, with a more than 4-to-1 registration advantage over Democrats and overwhelming majorities in both legislative chambers. Bonner County, which includes Sandpoint, backed President Donald Trump by a 2-to-1 margin in the 2016 election.
But the state also has a fierce independent streak that’s been apparent in its approach to Obamacare. It’s the only Republican-led state to fully run its own health insurance marketplace, which has been far more competitive than others in similarly sparsely populated states. Yet even while creating that unexpected success story, state officials this year pushed a proposal to create skinnier health plans exempt from Obamacare rules, and lacking protections for pre-existing conditions. It was too radical even for the Trump administration.
Now Mayville is attempting to turn that independence into a grassroots revolt: In the campaign’s final 30 days, he plans to hit all 44 Idaho counties, often in the ramshackle green “Medicaid Mobile” that has become a kind of mascot for the campaign.
Medicaid expansion has proven a bridge too far for the state’s conservative lawmakers, who’ve rebuffed numerous proposals to cover low-income residents. That drove Medicaid expansion supporters to take matters into their own hands, organizing an 18-month statewide campaign to get it on the ballot.
“[People] got very frustrated with the fact that the legislature was not able to do something, and they really took it upon themselves to come out and start an initiative process, which is very rare in this state,” said state Rep. Christy Perry, a Republican, who is co-chairing the campaign to pass the ballot referendum and championed the most recent failed legislative effort to expand coverage. “And for me, that gives me hope.”
Republican Lt. Gov. Brad Little, the easy favorite to win November’s gubernatorial contest, said he hasn’t ruled out voting for the Medicaid referendum, which would cover more than 60,000 Idahoans. He’s also not threatening to follow the path of LePage and block implementation if it passes.
“I’m fully committed to honoring the will of the people if that happens,” Little said.
The Republican-dominated Legislature, which would have to fund the program, could be less accommodating. Staunch Obamacare foes in the state who haven’t given up on the law’s repeal will likely pressure lawmakers to ignore voters if the ballot measure is successful.
“I think we’re at a fork in the road,” said Fred Birnbaum, vice president of the Idaho Freedom Foundation, the main group fighting the referendum. “If Idaho and Utah and Montana [and] Nebraska and other states expand Medicaid, it will be harder for Congress to reverse that. I think that is going to put us on the path to a … single-payer system.”
Opponents of the measure argue Medicaid expansion has proven more expensive than projected in other states that have moved forward and could jeopardize funding for other crucial services such as education and transportation. They also believe it could prove a disincentive to work, since beneficiaries could be putting their health care coverage at risk if they make too much money.
But the campaign has formidable support from pretty much the entire Idaho medical establishment, which would benefit greatly from such an expansion because more of their patients would be able to pay their bills. The Idaho Hospital Association, the biggest financial supporter, has contributed $150,000. The Idaho Medical Association, the state’s largest physician organization, has chipped in nearly $50,000.
A poll conducted this summer showed a whopping 70 percent of Idahoans support closing the “coverage gap” by expanding Medicaid. The coverage gap refers to individuals in Idaho and other non-expansion states that make too much to qualify for Medicaid, but too little to access Obamacare’s subsidies for private insurance. They’re essentially left with no options for obtaining coverage.
A huge unmet need for care
Jessica and Patrick Rachels, who have twice gone out knocking on doors to support the referendum, are among the Idahoans who could gain coverage. Jessica Rachels is a mother of four and full-time caregiver for her 12-year-old daughter born with severe mental and physical disabilities. She also takes care of her elderly father, who lives with them and struggles with diabetes and Parkinson’s disease. Patrick is a self-employed computer technician. Their household income is about $25,000.
“I make enough to pay the bills and get things fixed and barely get my head above water,” Patrick Rachels said, during a recent interview at their home just outside of Sandpoint.
Their children are all covered through Medicaid, but Jessica and Patrick have been without coverage most of their adult lives. The income cutoff for Medicaid eligibility for parents with four kids in Idaho is about $7,000, far stingier than in many other states. Under expansion that threshold would rise to about $33,000.
More
www.politico.com/story/2018/10/19/medicaid-expansion-trump-country-864421
