2‑minute read

Join our guest blogger, Devin McBrayer, as she explains how the results of the midterm election affect Medicaid expansion across the country. Devin is a Legislative and Policy Analyst based in Sacramento, California.

The 2018 midterm election revealed that many Americans support Medicaid expansion: Three of four states with expansion on the ballot voted to approve it, and two of four gubernatorial candidates supporting Medicaid expansion won election. If these states are successful in growing their programs, access to dental care for low-income Americans will likely increase. However, the futures of these states’ Medicaid programs face political and financial obstacles.

Utah, Nebraska and Idaho voters approved expanding coverage to 300,000 low-income Americans, yet these states are already experiencing pushback or challenges:

  • In Idaho, while the ballot initiative to expand Medicaid passed with more than 60% of voters, Republicans in the state have filed a lawsuit against the ballot initiative saying that it violates parts of the state’s constitution.
  • Implementation efforts in Utah are likely to be blocked by conservatives in the state House of Representatives.
  • The Nebraska state legislature faces the difficult task of figuring out how to pay for the program.

Meanwhile, Montana voted to allow their existing Medicaid expansion to sunset in 2019, which means Montanans who previously gained health care coverage will lose it on January 1, 2019.

Complicating matters, in all states the 100% federal funding match for newly eligible Medicaid enrollees has begun to phase down. By 2020 the match will drop down to 90%, which will force states to finance a greater share of expansion costs. 

Aside from ballot initiatives, four gubernatorial candidates ran with Medicaid expansion as a core part of their political platform. Two Democratic candidates supporting expansion won their races and flipped their state executive office, but the path to expansion isn’t clear.

  • In Wisconsin, Republicans in the state Assembly and Senate have already passed bills that could limit the powers of Governor-elect Tony Evers, including his Medicaid expansion efforts.
  • In the Kansas election that put Democrat Laura Kelly in the governor’s office, voters also elected a more conservative Legislature. Any bill seeking to expand Medicaid in Kansas will now have a tougher time getting to the governor’s desk.

The gubernatorial candidates supporting Medicaid expansion in Florida and Georgia lost their races, further lowering the possibility for expansion in these states.

Delta Dental will continue to monitor the impact of these elections and other trends that could have major impacts on low-income adults’ access to dental benefits and care across the country.

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