Medicaid Expansion Under Obamacare On the Ballot in 4 States

Voters in four states could vote to expand their state’s Medicaid program under the Affordable Care Act (aka Obamacare) this November.

Under Obamacare, states were given the ability to expand their Medicaid program to cover individuals earning up to 138% of the federal poverty level with financial assistance from the federal government that decreased over time. The federal government initially covered 100% of the cost of expansion, which dropped to 95% in 2017 and is set to continue decreasing gradually to 90% in 2020.

Here’s a look at the ballot measures:

Utah Proposition 3 would require the state to expand Medicaid under the Affordable Care Act (aka Obamacare) by providing eligibility to people under age 65 with incomes equal to or below 138 percent of the federal poverty line. To finance the state’s cost of Medicaid expansion, the sales tax would be increased from 4.70 to 4.85 percent.

In 2018, the Utah legislature and governor enacted an alternative, partial expansion of Medicaid that included a work, volunteer, or educational requirement to qualify that would cover about 70,000 people (as opposed to 150,000 under Proposition 3’s full expansion). It requires a federally-approved waiver which likely won’t be approved or denied until after the election.

Nebraska Initiative 427 would require the state government to expand Medicaid under the Affordable Care Act (aka Obamacare) by making eligible persons under the age of 65, whose incomes equal or fall below 138 percent of the federal poverty line (which in 2018 amounts to $16,753 for an individual or $34,638 for a family of four).

If passed, the Nebraska Dept. of Health and Human Services would be required to filed a state expansion plan with the federal Centers for Medicare and Medicaid Services on or before April 1, 2019.

Montana I-185 would eliminate the June 30, 2019 expiration date for expanded Medicaid eligibility and raise taxes on all tobacco products (including e-cigarettes and vaping products) to fund the expanded coverage with up to $26 million per fiscal year. Taxes would be increased $2 per pack, bringing the total taxes on a pack of cigarettes to $3.70 while all other tobacco products would be taxed at 33% of their wholesale price.

Revenue from the tobacco taxes would also go to smoking prevention & cessation programs (up to $3 million/yr), veterans’ services & suicide prevention (up to $2 million/yr), in addition to home and community-based Medicaid waiver services (up to $5 million/yr).

Idaho Proposition 2 would expand Medicaid eligibility to more individuals under the Affordable Care Act (aka Obamacare). It’d expand eligibility to those under 65 years old whose income is 133 percent of the federal poverty level or below and aren’t eligible for other state insurance coverage.

Idaho currently has a program aimed at meeting the healthcare needs of low-income people who don’t qualify for other state or federal health and welfare programs ― the Catastrophic Health Care Fund (or CAT fund) which cost $33.9 million in 2016. It requires counties to cover the first $11,000 in medical bills a medically indigent person incurs, while the state covers all medical bills above $11,000.

The Idaho Dept. of Health and Welfare commissioned a report on the cost of Medicaid expansion, which it put at $4.796 billion between fiscal years 2020-2030.

— Eric Revell

(Photo Credit: iStock.com / zimmytws)