2. Medicaid expansion
The Supreme Court in 2012 made optional the ACA’s expansion of Medicaid to cover all low-income Americans up to 138% of the poverty line ($16,753 for an individual in 2018). Most states have now expanded, particularly since the federal government is paying the vast majority of the cost: 94% in 2018, gradually dropping to 90% in 2020.
Still, 17 states, all with GOP governors or state legislatures (or both), have yet to expand Medicaid.
Mr. McDonough is confident that’s about to change. “I’m wondering if we’re on the cusp of a Medicaid wave,” he said.
Four states – Idaho, Montana, Nebraska, and Utah – have Medicaid expansion questions on their ballots. All but Montana have yet to expand the program. Montana’s question would eliminate the 2019 sunset date included in its expansion in 2016. But it will be interesting to watch results because the measure has run into big-pocketed opposition: the tobacco industry. The initiative would increase taxes on cigarettes and other tobacco products to fund the state’s increased Medicaid costs.
In Idaho, the ballot measure is being embraced by a number of Republican leaders. GOP Gov. Butch Otter, who is retiring after three terms, endorsed it Oct. 30.
But the issue is in play in other states, too. Several nonexpansion states have close or closer-than-expected races for governor where the Democrat has made Medicaid expansion a priority.
In Florida, one of the largest states not to have expanded Medicaid, the Republican candidate for governor, former U.S. Rep. Ron DeSantis, opposes expansion. His Democratic opponent, Tallahassee Mayor Andrew Gillum, supports it.
In Georgia, the gubernatorial candidates, Democrat Stacey Abrams and Republican Brian Kemp, are also on opposite sides of the Medicaid expansion debate.
However, the legislatures in both states have opposed the expansion, and it’s not clear if they would be swayed by arguments from a new governor.
3. Medicare
Until recently, Republicans have remained relatively quiet about efforts to change the popular Medicare program for seniors and people with disabilities.
Their new talking point is that proposals to expand the program – such as the often-touted “Medicare-for-all,” which an increasing number of Democrats are embracing – could threaten the existing program.
“Medicare is at significant risk of being cut if Democrats take over the House,” Rep. Greg Gianforte (R-Mont.) told the Lee Montana Newspapers. “Medicare-for-all is Medicare for none. It will gut Medicare, end the VA [Department of Veterans Affairs] as we know it, and force Montana seniors to the back of the line.”
Gianforte’s Democratic opponent, Kathleen Williams, is proposing another idea popular with Democrats: allowing people aged 55 years and over to “buy into” Medicare coverage. That race, too, is very tight.
Meanwhile, back in Washington, congressional Republicans are more concerned with how Medicare and other large government social programs are threatening the budget.
“Sooner or later we are going to run out of other people’s money,” said Mr. Jacobs.
Senate Majority Leader Mitch McConnell (R-Ky.) suggested in an Oct. 16 interview with Bloomberg News that entitlement programs like Medicare are “the real driver of the debt by any objective standard,” but that bipartisan cooperation will be needed to address that problem
Republican Mr. Jacobs and Democrat Mr. McDonough think that’s unlikely any time soon.
“Why would Democrats give that up as an issue heading into 2020?” asked Mr. McDonough, especially because Republicans in recent years have been proposing deep cuts to the Medicare program.
Agreed Mr. Jacobs, “Trump may not want that to be the centerpiece of a reelection campaign.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.