Midterm election boosts Medicaid expansion, but challenges remain

Medicaid — which has been a political football between Washington and state capitols during the past decade — scored big in Tuesday’s election. Following the vote, nearly 500,000 uninsured adults in five states are poised to gain Medicaid coverage under the Affordable Care Act, advocates estimate. Three deep-red states passed ballot measures expanding their programs and two other states elected governors who have said they will accept expansion bills from their legislatures. Supporters were so excited by the victories they said they will start planning for more voter referendums in 2020. Medicaid proponents also were celebrating the Democrats’ takeover of the House, which would impede any Republican efforts to repeal the ACA and make major cuts to the federal-state health insurance program for low-income people. "Tuesday was huge for the Medicaid program," said Katherine Howitt, associate director of policy at Community Catalyst, a Boston-based advocacy group. "The overall message is that the electorate does not see this as a Democrat or GOP issue but as an issue of basic fairness, access to care and pocketbook issue. Medicaid is working and is something Americans want to protect." But health experts caution that GOP opposition won’t fade away. David Jones, an assistant professor in the Department of Health Law, Policy and Management at Boston University, said ballot organizers now have a blueprint on how to expand Medicaid in states that have resisted. "I see this as a turning point in ACA politics,” he said. Still, he added? "it’s not inevitable.” Medicaid is the largest government health program, insuring at least 73 million low-income Americans. Half of them are children. To date, 32 states and the District of Columbia have expanded it under the ACA. Before that law, Medicaid was generally limited to children, sometimes their parents, pregnant women and people with disabilities. The ACA encouraged states to open the program to all Americans earning up to 138 percent of the poverty level ($16,753 for an individual in 2018). The federal government is paying the bulk of the cost: 94 percent this year, but gradually dropping to 90 percent in 2020. States pay the rest. GOP opposition has left about 4.2 million low-income Americans without coverage in various states. "It’s not over until it’s over is the story of Medicaid expansion and the Affordable Care Act as the politics never ends and the opportunity for obstruction never ends,” said Jones. "But the trend overall has been to increasing implementation and increasing coverage.” Montana Fails To Endorse Funding Two years after President Donald Trump carried Idaho, Nebraska and Utah by double-digit margins with a message that included repeal of the ACA, voters in those states approved the ballot referendums Tuesday. Together, the states have about 300,000 uninsured adults who would be eligible for the program. In addition, Democrats secured the governor’s offices in Kansas and Maine, which will increase the likelihood those states pursue expansion. Legislatures in both states have previously voted to expand, only to have GOP governors block the bills. Maine voters also passed a referendum in 2017 endorsing expansion, but Republican Gov. Paul LePage again refused to accept it. Current and incoming Republican governors in Utah and Idaho said they wouldn’t block implementation of the effort if voters approved it. Nebraska Gov. Pete Ricketts said Wednesday he would follow the will of the voters but would not support paying for it with a tax increase. It wasn’t a clean sweep, however, for Medicaid on Tuesday. In preliminary results, a ballot issue to fund Montana’s Medicaid expansion — which is already in place and slated to expire next July — was failing. Tobacco companies had mounted a campaign to stop the measure, which would have partially financed the expansion with taxes on tobacco products. The Montana legislature and the Democratic governor are expected to address the issue in the session that starts in January. No state has reversed its Medicaid expansion, even though GOP governors in Kansas and Arkansas have threatened to do so. Nearly 100,000 Montana residents have received Medicaid since its expansion, twice as many as expected. Nancy Ballance, the Republican chairwoman of the Montana House Appropriations Committee who opposed the bill that expanded Medicaid in 2015, said she is confident the state legislature will extend the program past July. But she expects the legislature to put some limits on the program, such as adding an asset test and work requirements. Related StoriesNew Xploro app helps reduce procedural anxiety in childrenSt. Jude Children's Research Hospital brings communities together to end childhood cancerBlood pressure in children affected by early environmental exposures"There are some people in the state who may not have disabilities but need some help to access coverage," she said. "I think we can pass something without people having a gap in coverage. … That will be a priority." "It was never our intent to simply sunset the expansion and have it go away," she said. Rather, the legislature put the sunset provision in to revisit the provision to make any changes. Chris Jacobs, a conservative health policy analyst in Washington, D.C., said the Montana results showed that when voters are given a choice of having to pay for Medicaid expansion through a new tax they were not willing to go along. But in Utah, voters did agree to fund their state plan by adding 0.15 percent to the state’s sales tax, just over a penny for a $10 purchase. Fernando Wilson, acting director of the Center for Health Policy at the University of Nebraska Medical Center, said the vote on the state’s ballot question indicated many people wanted to help 80,000 uninsured Nebraskans gain coverage. "I think it showed there was a clear need for it,” he said. The legislature likely won’t block the expansion, Wilson said, though it may try to add a conservative twist such as adding premiums or other steps. Sheila Burke, a lecturer in health policy at Harvard Kennedy School, said voters approved Medicaid expansion not just because it would help improve health coverage for their residents but to help stabilize their hospitals, particularly those in rural areas. Hospitals have said this step helps their bottom lines because it cuts down on uninsured patients and uncompensated care. "The broad population does see the value of Medicaid,” she said. "They saw it as a loss by their states not to accept the federal funds,” she said. Despite the victories, Burke said, advocates should not assume other states such as Florida, Texas and Tennessee will follow suit. "I don’t see a radical shift, but it moves us closer,” she said. ‘Fertile Ground’ For More Referendums If advocates press for more referendums, Florida might be a tempting target. More than 700,000 adults there could become eligible, but the campaign would likely also be very costly. Jonathan Schleifer, executive director of The Fairness Project, which financed the ballot initiatives in Maine in 2017 and the four states this year, refused to say which states would be targeted next. The group is funded by the Service Employees International Union-United Healthcare Workers West, a California health care workers union. "The GOP has been bashing the ACA for nearly a decade, and voters in the reddest states in the country just rejected that message," Schleifer said. "It's a repudiation and a tectonic shift in health care in this country." "There is fertile ground" for more such ballot votes, said Topher Spiro, vice president for health policy at Center for American Progress, a liberal think tank. "It is clear that public opinion is on the side of Medicaid expansion and the election results merely confirm that." "This will build momentum for expansion in other states," he added. The election results also could have consequences on efforts by states to implement work requirements for Medicaid enrollees. New Hampshire and Michigan — which expanded the program but recently won federal approval to add controversial work requirements — could revisit that additional mandate as a result of Democrats winning control over both houses of the legislature in New Hampshire and the governor’s office in Michigan.

相关文章

健康 2019-12-31
一项新的研究发现了有助于医疗保健提供者识别糖尿病患者的危险因素,这些患者很可能患有低血糖症。由美国和加拿大以外的Regenstrief研究所、印第安纳大学医学院和默克公司(Merck)的研究人员开发和
健康 2019-12-31
科学家们已经知道肠道中的细菌,以及环境和遗传因素,会导致克罗恩病(CD)的肠道疾病。但是在2016年,MahmoudAGhannoum,博士,FAAM,FIDSA,克利夫兰医学中心凯斯西部储备医学院和
健康 2019-12-31
路易斯维尔大学的研究人员开发了一个易于复制的系统,使他们能够使人的心脏片在更长的时间内保持活力,允许对新药物和基因疗法进行更广泛的测试。这种新的仿生培养系统通过连续的电刺激和氧合来模拟活器官的环境,维
健康 2019-12-31
全球体外诊断公司EKFDiagnostics宣布,美国食品和药物管理局(FDA)最近批准在美国销售的糖化白蛋白(GA)液体酶法检测将在2019年AACC临床实验室博览会(8月6日至8日,加利福尼亚州阿
健康 2019-12-31
根据由北卡罗来纳大学Lineberger综合癌症中心研究员领导的研究结果,治疗后监测频率更高的前列腺癌患者的寿命并不明显长于每年监测一次的患者。在芝加哥召开的2018年美国临床肿瘤学会年会上,研究人员
健康 2019-12-31
由于联邦法规的变化,从2013-2017年,医疗保险和医疗补助服务中心(CMS)修订了任何医疗保健遭遇,包括医疗保险和医疗补助可识别文件中与药物滥用有关的诊断或程序代码。结果很难确定研究人员、政策分析
健康 2019-12-31
初步研究结果表明,睡眠和瑜伽干预对改善睡眠障碍、睡眠相关损害和睡眠健康行为具有良好的效果。睡眠问题在低收入群体中很常见,但往往未得到充分的认识和治疗,并且常常与睡眠健康行为、压力和不利的环境条件有关。
健康 2019-12-31
LonzaPharma&Biotech和InnosweaveDiagnostics今天宣布了一项快速生物负载测试技术的独家经销协议。该协议扩大了Lonza对内毒素产品、服务和软件的广泛供应,并为药品检
健康 2019-12-31
SmokeFreeBrain汇集了毒理学、肺医学、神经科学、行为疗法以及健康经济学和健康信息学方面的专家。他们正在研究针对中高收入国家的高危人群(如失业的成年人、患有慢性肺疾病和哮喘患者的人)以及中低
健康 2019-12-31
佐治亚理工学院的研究人员发现了一种涉及视觉感知的机制,这种机制让人们相信他们所看到的是真实的。图片来源:poptika/shutterstock.com科学家们发现两个大脑区域协同工作产生了这种视觉自
健康 2019-12-31
今天发表的一份新报告强调了皮肤癌领域的不同研究领域,表明免疫疗法是最突出的课题,并揭示了推动这项研究的国家。“黑色素瘤研究见解:影响、趋势、机遇”研究报告于2013-2018年间由信息分析公司Else
健康 2019-12-31
赛诺菲英国对1981年至1996年出生的2000名英国消费者进行的一项最新调查结果表明,从健康的生活方式角度来看,千禧一代是自信的自我护理者。在被调查者中,67%的人表示他们非常或有点自信通过自我保健
健康 2019-12-31
斯特拉斯克莱德大学的科学家领导的一项研究提出了一种新的方法,即集中放疗剂量,同时尽量减少对健康细胞的损害。这项研究提出,将高能粒子束聚焦在身体深处的一个小点上,有可能使临床医生能够精确地瞄准癌性肿瘤,
健康 2019-12-31
根据发表在《总体环境科学》杂志上的一项研究,防止蚊子的引入和减少其种群是控制这种外来鱼类在池塘和湖泊中扩散的最有效措施。无论是捕食者的存在,还是水质和自然栖息地的退化,都不会对这种入侵物种构成威胁——
健康 2019-12-31
来自Gero、Skolkovo科学技术研究所(Skoltech)、莫斯科物理技术研究所(MIPT)和阿肯色大学医学科学院(UAMS)的研究人员合作获得了一个衰老的转录组学特征,他们使用大的转录组学数据
健康 2019-12-31
弗雷森尤斯,美国最大的两个透析提供者之一,已经同意免除524600.17美元的议案,为一个在蒙大拿州的诊所接受14周透析的男子。凯撒健康新闻,NPR和CBS今天早上告诉主权情人节这个星期的故事,作为“
健康 2019-12-31
奥塔戈大学的学者们发明了一种可以帮助减轻全球意外怀孕负担的装置。本发明将使助产士等接生人员在妇女分娩后立即插入宫内节育器(IUD)更安全、更容易。其中一位发明者,妇女和儿童健康部的副教授迈克尔·斯蒂利
健康 2019-12-18
利物浦大学领导的一个研究联盟在“抗菌剂和化学疗法”上发表了一项新的研究,它帮助开发了一种新的治疗方法来治疗某些耐多药(MDR)感染。抗菌素耐药性(AMR)是一种全球性的严重威胁,对人类健康造成严重威胁
健康 2019-12-18
萨斯喀彻温大学(USASK)的研究表明,脑震荡症状——如失去平衡、理解模糊、睡眠障碍和直立行走能力——可以通过一种新型的磁刺激来逆转。根据发表在《神经学杂志》上的一项研究,每天使用一台笔记本型设备进行
健康 2019-12-18
长期以来,女性被告知昏厥是怀孕的一种常见但无害的症状,但最新研究表明,昏厥可能对婴儿和母亲的健康都有影响,尤其是在怀孕的前三个月。这项由阿尔伯塔大学高级流行病学家PadmaKaul和卡尔加里大学心脏病
健康 2019-12-18
尽管精神疾病可能与特定的基因有关,但对特定疾病的大脑区域和机制还不太清楚。Shank3基因的突变或缺失与孤独症谱系障碍(ASD)和一种称为Phelan-McDermid综合征的相关罕见疾病密切相关。s
健康 2019-12-18
梅奥诊所的研究人员发现,越来越多的疲乏症状和住院医师种族偏见的加剧之间存在联系。这项研究发表在JAMA网络公开赛上。当医生没有在最佳的精神和情绪状态下进行手术时,他们可能会发现很难克服自己的偏见,如果
健康 2019-12-18
在《骨科研究杂志》上发表的一项研究中,研究者们发现了尿路标志物,这些标志物可以区分最终导致骨组织破坏或骨溶解的全髋关节置换患者和不发生骨溶解的患者。在这项研究中,研究人员使用了一个24小时尿液样本的储
健康 2019-12-18
阿尔茨海默氏症药物发现基金会(ADDF)今天宣布了第一组研究者,他们将通过其诊断加速器来获得资金,这是一项新的研究项目,旨在快速追踪阿尔茨海默病和相关痴呆症的诊断工具和生物标志物的发展。AS。在一个慈
健康 2019-12-18
约40%的亨廷顿氏病患者(一种神经变性病理学)表现出抑郁症状,甚至在疾病典型运动症状出现之前的早期阶段。一项临床前研究表明,CDK5激酶(一种在多种细胞信号传导途径中起重要作用的酶)的功能改变可以解释
健康 2019-12-18
最近的一项研究表明,杀虫剂会阻止线粒体正常工作,导致人类神经元细胞死亡,并增加对帕金森病的易感性。图片来源:katerynakon/shutterstock这项研究最近发表在FASEB杂志上,发现即使
健康 2019-12-18
丹娜法伯癌症研究所兰克泌尿生殖肿瘤中心的MBBS克里斯托弗·斯韦尼在美国期间发表的一项大型研究表明,口服雄激素受体抑制剂enzalutamide可以改善转移性激素敏感型前列腺癌(mhspc)患者的预后
健康 2019-12-18
在贫困中长大,经历过严重事故或性侵犯等创伤性事件,可能会影响儿童和年轻人的大脑发育和行为。本周发表的一项新研究表明,社会经济地位低下(L-SES)和创伤性应激事件(TSES)的经历与青春期和大脑成熟加
健康 2019-12-18
伦敦国王学院的研究人员已经使用单细胞RNA测序来鉴定一种可以再生肝组织的细胞,这种细胞可以在不需要移植的情况下治疗肝衰竭。在今天发表在《自然通讯》上的一篇论文中,科学家们发现了一种新的细胞,叫做肝胆杂
健康 2019-12-18
一种广受欢迎的水族馆鱼可能对儿童癌症中肿瘤的形成有着答案。肌肉前体细胞称为肌母细胞,在正常胎儿发育过程中形成,成熟后成为身体骨骼肌。很少有一种遗传错误,即两条染色体的片段融合在一起,发生在一个与这个过