Health care featured prominently in the run up to the 2018 midterm elections. Many congressional and gubernatorial campaigns included discussion of the Affordable Care Act and pre-existing conditions, and Medicaid expansion itself was on the ballot in four states. The election results likely will impact the extent of Medicaid coverage and provider participation in many states. The following is a brief overview of Tuesday's Medicaid-related election outcomes:

Ballot measures to expand Medicaid passed in traditionally conservative Idaho and Nebraska and is likely to succeed in Utah as well, where the Republican legislature repeatedly blocked expansion efforts.

  • Idaho. Idaho Proposition 2 requires the state to expand Medicaid eligibility as permitted by the Affordable Care Act.
  • Nebraska. Initiative 427 requires the state's Department of Health and Human Services to file a state expansion plan with the Centers for Medicare and Medicaid Services (CMS) on or before April 1, 2019. The expanded population will be consistent with what is permitted by the Affordable Care Act.
  • Utah. Utah Proposition 3 would expand Medicaid eligibility as permitted by the Affordable Care Act, funded by an increase in the state sales tax to 4.85%. At this writing, with 88 percent of votes tallied, 54 percent are in favor of expansion.

In addition to the Medicaid expansion ballot initiatives, several state elections and ballot measures will likely impact Medicaid.

  • Kansas. In the spring of 2017, a Republican-dominated Kansas legislature approved Medicaid expansion. Then-Republican Governor Sam Brownback vetoed the legislation, saying the cost to the state would be "unsustainable and irresponsible." Democratic state Senator and Governor-elect Laura Kelly focused her campaign on Medicaid expansion and will likely move to expand the program in the state.
  • Maine. In the fall of 2017, Maine voters approved a ballot measure to expand Medicaid. Then-Governor Paul LePage, a Republican, strongly opposed and refused to implement the expansion measure. The successor elected on Tuesday, Democrat Janet Mills, has committed to move forward with Medicaid expansion.
  • Montana. With votes still being tallied throughout Montana late Wednesday, a ballot initiative to raise tobacco taxes on all tobacco products, including electronic cigarettes, to fund expanded Medicaid eligibility, appeared headed for defeat. If Ballot Initiative 185, which has been strongly opposed by cigarette manufacturers, fails, this may raise questions regarding the future of Medicaid expansion in Montana. Democratic Governor Steve Bullock (and 2020 presidential hopeful) has warned of budget constraints. The next two-year budget is set to come out November 15, which could give a clearer picture of the administration's larger spending plans and priorities within the state health department.
  • North Carolina. Although Republicans still control both chambers of the state General Assembly, Democrats won enough seats in Tuesday's elections to take away Republicans' veto-proof super majorities in both the state House and Senate. Democratic Governor Roy Cooper may work with Republican leaders to craft a Medicaid expansion proposal.
  • Wisconsin. Republican Governor Scott Walker was defeated by Democratic candidate Tony Evers who campaigned on a platform that included Medicaid expansion. However, Republicans maintained control of the state legislature, which previously rejected expansion.

This article was co-authored by Tesch West, a Health Care Law Clerk in the New York office.

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