Republican-led Congress has repeatedly blocked the expansion of Medicaid in 12 conservative states despite large numbers of uninsured residents. increase. It’s about letting voters decide.
Since 2017, the seven states where the issue has been voted on have passed Medicaid expansions, adopting Affordable Care Act provisions that provide health insurance to hundreds of thousands of people living at or near the poverty line it was done.
South Dakota voters adopted the program last month after bypassing the state’s conservative legislature. But the momentum of his November election victory was fleeting.
In the remaining two states, Florida and Wyoming, where voters have a choice, high costs and other hurdles built into the voting process have made enacting legislation nearly impossible. Yes, supporters say.
“Each of these states has had a particularly difficult time getting their Medicaid expansion ballot bills passed for a variety of reasons,” said Kelly Hall, executive director of the Fairness Project, who said it was “an effective strategy.” The Washington, D.C.-based nonprofit funded Medicaid voting campaigns in multiple states, raising minimum wages and guaranteeing paid sick leave for workers. and other progressive causes.
So supporters will have to appeal to Republican lawmakers in 11 Southern or Midwestern states where opposition to the health act, also known as Obamacare, has softened but remains entrenched.
Ten years after the Supreme Court ruled that the federal government cannot compel states to provide Medicaid benefits to low-income adults, millions of people still have insurance. I have not joined.a KFF estimation It found that 2.2 million uninsured adults without other coverage options in resistant states would qualify before the pandemic.
Leaders of Florida Decides Healthcare, a citizen-led initiative to push for the expansion of Medicaid, are confident voters will approve it despite years of Republican refusal. . But the group’s campaign, his manager, Jake Flaherty, said he was the earliest to submit a ballot measure, given the enormous financial and logistical hurdles to launch the campaign in the Sunshine State. said to be 2026.
For a question to reach a vote, backers must collect signatures equivalent to 8% of the total voter turnout in the most recent presidential election, or nearly 900,000 signatures. Signatures must also match at least 8% of the votes cast in that election in at least half of each of the state’s 28 congressional districts.
Any bill must undergo review by the Florida Supreme Court, but only after the proponent gathers a quarter of the required signatures from half of the state’s congressional districts. For this bill to pass, her 60% of Florida voters would need to support it.
Recent legislative changes to the initiative process — limiting time to collect signatures, prohibiting sponsors from paying activists based on the number of signatures they get, and requiring petition circulators to register with the state and others — have prevented the Political Action Committee from proposing the initiative. Flaherty said.
“What surprised people was that the process changed so much that they believed it wouldn’t work,” he said.
He said the change would make “Florida an even taller hill to climb.” Lucy dannyotis the senior campaign director for the American Cancer Society Cancer Action Network, the political arm of the nonprofit, and has supported Medicaid voting campaigns.
Florida legislators also tried twice to limit donations, but federal judges blocked enforcement of those laws.
The change has caused some of the largest donors to Florida initiatives, including the Fairness Project, to suspend financial support.
Holly Bullard, member of Florida Decides Healthcare’s Executive Committee, said: “While we have made the decision to work with our grassroots partners from Pensacola to Little Her Havana, aiming for her 2026, that is not the model that the Fairness Project has specifically pursued.”
Hannah Ledford, campaign director for the Fairness Project, said: She said the group “is not ready to push advocacy for years, possibly decades.”
Since 2019, the Fairness Project has donated over $400,000 in legal services, printing costs, and other in-kind donations to the group. The last donation was in October 2020, according to. Florida campaign finance data.
Flaherty estimates that participating in the vote will cost at least $10 million. This is based on paying the circulator a flat rate of $20 per hour, he said. For messages to voters, he estimates another $10 million. These costs are significantly higher than Medicaid voting campaigns in other states.
Flaherty said the group had about $250,000 on hand as of November. Past donors include Service Employees International Union, Planned Parenthood, Florida Voices for Health, and Florida Policy Institute.
In Wyoming, voters last enacted citizen-led legislation in 1992, according to vote-tracking website Ballotpedia: state regulation Because Medicaid is jointly funded by federal and state governments, the ballot measure cannot force lawmakers to get the appropriate funding, it said.
“A safer route, and one that doesn’t threaten people’s coverage, is through Congress,” Dano said.
Healthy Wyoming advocacy group Jean Cartwright says the voting campaign is “not for the faint of heart.”
Supporters in Wyoming believe Congress will do the best because it has Republican support there.
In November, the Wyoming legislative committee approved the bill after Montana Rep. Edward Butley testified about how the state has benefited since 2015. Republicans testified.
“If someone is unhealthy or addicted, they simply cannot contribute to the success and health of themselves or their country,” Buttrey said.
Wyoming Representative Steve Hirschman, also a Republican, is listening. “I voted against this probably ten times,” he said. “I changed my mind. I learned more. I think that’s really good for our state.”
Wyoming Department of Health Estimated about 19,000 people Register within the first two years.
The Wyoming House of Representatives passed the expansion bill in 2021, but a state Senate committee rejected the bill, leaving opponents in the Republican-controlled Congress.
Republican State Senator Tom James voted against the bill in November. “Every employer I’ve worked for has had insurance options,” he said. “We had the option of not accepting it. We want to make sure we cover people who don’t have insurance options.”
In other states that have not expanded, little has changed. Georgia’s re-elected Republican Governor Brian Kemp said: commit to implementation A small program that provides Medicaid benefits to an additional 50,000 adults and requires jobs and volunteers.
But in some states, other factors could increase the likelihood of business expansion next year, Dugno said.a financial incentives According to the American Relief Plans Act of 2021, Medicaid funding in newly expanded states will increase by 5 percentage points over two years, more than offsetting the cost of insuring more people. KFF estimate.
And millions are on Medicaid as the Department of Health and Human Services ends the covid-19 public health emergency may lose their profitsA federal order prevented states from kicking people off Medicaid during the pandemic.
That mandate guaranteed compensation for millions of Americans who otherwise might not have it and created support for Medicaid expansion, proponents say.
“The pandemic has changed many people’s attitudes about whether they need medical insurance,” Dugno said.
Proponents believe North Carolina is the next most likely state to expand the program, targeting an estimated 400,000 uninsured people. Democratic Governor Roy Cooper and Republican leaders in the North Carolina legislature supported the move, but no compromise was reached.
John Locke Foundation, a conservative think tank in North Carolina, oppose expansion Because, among other reasons, it creates an unsustainable financial burden. But the state seems to be a pending pattern.
Its senior political analyst Mitch Kokai said:
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three major operational programs in the United States, along with policy analysis and polling KFFMore (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the public.
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