Medicaid is having a moment. Over the past twelve months, the 52-year-old health care program for low-income Americans has survived numerous existential threats in Congress and emerged vindicated. In July, and again in September, pundits and activists hailed the defeat of Senate bills to restructure Medicaid funding (and repeal the Affordable Care Act) as proof of the program’s growing popularity with the American public.
That popular sentiment translated into votes on Election Day, as a voter referendum in Maine approved Medicaid expansion and concerns over health care propelled Lt. Gov. Ralph Northam to the governor’s mansion in Richmond.
Maine’s successful ballot proposal to expand Medicaid to more than 80,000 low-income Mainers was the culmination of years of work by activists in the state, who took the issue to the public to bypass Gov. Paul LePage. LePage, whose current approval rating rovers around 40 percent, has vetoed legislation to expand Medicaid five times since 2012 and this week pledged to block the ballot initiative, despite having no legal process to overturn the proposal approved by 60 percent of voters.
The overwhelming support for Medicaid in Maine, one of 19 states that rejected expansion authorized by the ACA, comes as other GOP-controlled states like Utah and Idaho consider similar ballot measures. Additionally, the successful “yes” vote almost certainly guarantees Maine’s U.S. Senator Susan Collins’ continued support of the landmark health law. Her refusal to gut Medicaid spending doomed the Senate’s earlier ACA repeal efforts and increased, among Mainers, both the program’s popularity and her own.
In Virginia, large Democratic wins, while not surprising (Obama won the state twice, as did Clinton last year), could lead to major changes in health care policy in the commonwealth. A Washington Post exit poll found that health care was the primary concern for nearly 40 percent of voters, far ahead of taxes, immigration and gun control. Of voters who cast their ballot for Northam, himself a physician, 78 percent said health care was their chief concern.
However, it is unexpected wins for Democrats in the Virginia House of Delegates that have the potential to shake things up in Richmond. Pending results from recounts in a few incredibly close races, Democrats are within range to flip the House of Delegates and potentially pass Medicaid expansion, a failed goal of current Democratic Gov. Terry McAuliffe. An expansion of Medicaid for more than 400,000 Virginians would also change the calculus behind congressional repeal efforts, as many of GOP House members represent districts that would most benefit from expansion.
Obviously political predictions mean little in the unpredictable age of Trump, but these wins in Maine and Virginia go a long way in combatting the rhetoric coming from the president and his allies. The people of Maine sent a strong message that Medicaid works, while voters in Virginia signaled that politicians should work to build up and strengthen our health care system, not tear it down. The Medicaid program still faces many challenges from the Trump administration, but a change in momentum is palpable and people across this country are clearly interested in better health care solutions, not tired lectures about socialized medicine. In 2010 health care was a liability, in 2018 comprehensive, accessible health care will be a necessity.