Is Medicaid Expansion on the March?

Conservative predictions notwithstanding, Medicaid expansion continues to succeed in states willing to enact it.

By Nathan Pippenger

Tagged Health CareMedicaid

Amid so much bad political news, it was genuinely heartening last week to see Virginia finally expand Medicaid to nearly 400,000 low-income residents. The expansion follows last year’s wave of statewide Democratic victories, including the election of Governor Ralph Northam and a 15-seat gain in the House of Delegates that nearly erased the Republican majority. Although the GOP holds a 21-19 edge in the State Senate (elections for which will be held next year), four members broke ranks to approve expansion after the parties reached a deal to include work requirements, premiums for certain low-income recipients, and other restrictive measures. There’s no denying the downsides to these conditions: They will cause tens of thousands of people to lose coverage; they’ll be expensive to administer (cutting into the savings Virginia will likely realize from expansion); and in terms of encouraging workforce participation, they’ll probably be ineffective or even counterproductive. Even so, the long-sought expansion of health-care coverage, in a state where advocates had been trying without success for so long, is reason for celebration.

It’s also a good excuse to check in on the progress of Medicaid expansion in other states that, until recently, had been holdouts. (Let it not be forgotten that none of this effort would have been necessary had the Supreme Court not rendered Obamacare’s Medicaid expansion optional.) When I took note a couple of years ago as Louisiana began its expansion process, I cited dubious conservative predictions that neither low-income Americans nor the states in which they reside would benefit from Medicaid expansion—and that, indeed, it might even make them worse off. Subsequent developments have not borne out these dark prophecies. Consider first the skepticism about Medicaid’s impact on health outcomes: During the first several months of Louisiana’s 2013 expansion, a survey found that the uninsured rate among the state’s low-income adults had fallen from 42 percent to 15 percent, and on several measures of care, Louisianans reported better outcomes than similarly-situated Texans (who still await Medicaid expansion in their state). The study’s authors reported “significant gains in health coverage and access,” and they predicted further improvements with the passage of time.

That was last summer. This summer, a new report, prepared for the state’s Department of Health by a team of researchers at LSU, provides details on how Medicaid expansion has affected the state’s budget and its economy. The report concludes that the influx of federal money to cover more Louisianans has “created and supported almost 19,200 jobs, state tax receipts of just over $103 million, and local tax receipts of $74.6 million.” These jobs have softened the blow from a recent decline in the state’s oil and gas industry, and their economic and health benefits are dispersed throughout the state. About 1.7 million people in Louisiana are now covered by Medicaid, but millions of other Americans remain uninsured for no good reason. In three more states—Idaho, Nebraska, and Utah—ballot initiatives could lead to votes for expansion later this year. Voters there have an opportunity to take action where too many state legislatures have not. They should take guidance, and take heart, from the experience of the Pelican state.

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Nathan Pippenger is a contributing editor at Democracy. Follow him on Twitter at @NathanPip.

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