In 2010, President Obama signed into law the Affordable Care Act, which expanded eligibility for Medicaid. In 2012, the Supreme Court ruled that the federal government could not force states to participate in this Medicaid expansion. Now, in 2018, voters in four states will decide whether or not to embrace a Medicaid program that covers more people.
Medicaid is a federal program that provides health coverage to people with disabilities and people in poverty. It is jointly administered and funded by both the federal and state governments. The federal government mandates that certain people must be covered by the program; states can choose to expand coverage for others.
Under the ACA, or Obamacare, the federal government mandated Medicaid eligibility be extended to childless adults who live in households with incomes less than 138% of the federal poverty level. This was a departure from past practice, which focused coverage on parents, expectant mothers, children, and people with disabilities.
In a 2012 case, the Supreme Court ruled that the federal government could not force states to fund this higher-income population. Many states have decided to expand coverage on a voluntary basis, however. Some states resisted, citing budgetary concerns.
This year four states have ballot initiatives that would bypass legislators to expand Medicaid:
- Idaho: Proposition 2 would expand Medicaid to childless adults in households with an income less than 133% of the federal poverty level.
- Montana: I-185 would increase the state’s tobacco tax to expand Medicaid to childless adults in households with an income less than 138% of the federal poverty level.
- Utah: Proposition 3 would increase the state’s sales tax from 4.70% to 4.85% to pay for an expansion of Medicaid to childless adults in households with an income less than 138% of the federal poverty level.
- Nebraska: Initiative 427 would expand Medicaid to childless adults in households with an income less than 138% of the federal poverty level.
Another Medicaid initiative has already been approved by voters this year. Oregonians voted in favor of Measure 101 in January to approve a legislative expansion of Medicaid and a tax on insurance to fund it.
Supporters of allowing more people to access Medicaid argue that this will reduce the uninsured rate, leading to better health outcomes. They contend that since the federal govenrment is paying for the bulk of the expenses, this makes fiscal sense, too. Opponents counter that even with a small share of the Medicaid funding, this expansion could impose large costs on the state budget. They also argue that Medicaid was not intended to cover able-bodied adults with no children, and expanding it to this group will divert resources from children, parents, and people with disabilities.
Do you support expanding Medicaid to childless adults? At what income should Medicaid coverage be limited? Do you support increasing sales or tobacco taxes to pay for expanded Medicaid services?