Medicaid expansion is on the ballot in three states this year, where local Republican leadership have opposed the wholesale extension of the safety net program under the Affordable Care Act. Many GOP leaders have cited budget concerns.
Voters in Idaho, Nebraska and Utah will vote on expanding Medicaid in their states beginning in 2019. If the measures are passed, it could lead to new Medicaid coverage for 325,000 people across those three states, according to an analysis by Avalere.
Those ballot initiatives follow a successful binding referendum vote in Maine last year, where voters approved Medicaid expansion of the program to cover 70,000 low-income residents.
However, victory at the polls in Maine has not yet translated into actual implementation. Outgoing Republican governor, Paul LePage, has refused to carry out the measure despite court orders. He has argued that the state cannot afford the long term budget implications of coverage expansion.
Maine is one of half a dozen Republican-led states with tight gubernatorial races this year, and Democratic wins there could usher in a new wave of Medicaid expansion. Since the law was implemented in 2014, 34 states and Washington, DC have expanded Medicaid under the Affordable Care Act to date.
The ACA provision extends health care coverage under the safety net program to low-income adults earning up to 138 percent of the federal poverty level, which amounts to $16,600 for an individual this year, and up to $33,900 for a family of four.