The 2018 midterm elections certainly lived up to the drama they have promised for several months now. But behind the hype, there are very real consequences for healthcare policy. Here's a look at the impact of the 2018 midterms on Medicaid, healthcare reform, and social determinants of health.
Status of the Affordable Care Act
- As you know, Democrats won control of the U.S. House of Representatives, a win that could prove "a major reset of the political direction on health care" according to reporters at Politico.
- Most of the failed Obamacare repeal attempts over the years have originated in the Republican-controlled House. With Democrats now leading the House during the remaining years of President Trump's current term, the bedrock of the Affordable Care Act will remain secure for the time being.
Medicaid ExpansionOne of the main provisions of the Affordable Care Act is the option for all 50 states to expand Medicaid access and coverage for their residents. Since 2014, 33 states have elected to expand Medicaid under this provision.
- On Tuesday, voters in the conservative states of Idaho, Nebraska, and Utah also voted to expand Medicaid to an estimated 325,000 people in total starting next spring, according to the New York Times.
- An interesting turn of events occurred in Maine, where voters' wishes to approve Medicaid expansion last year were ignored by the outgoing Republican governor. This year, Mainers elected a Democrat to the office who has promised to immediately pursue Medicaid expansion for 70,000 state residents, in accordance with last year's referendum vote.
- Similarly, in Kansas, the outgoing Republican governor has vetoed efforts to expand Medicaid. Voters on Tuesday elected a Democrat to the office who is supportive of expansion.
- In North Carolina, Democrats ousted enough Republican incumbents in the state House on Tuesday to break the Republicans’ “supermajority” power over the Democratic governor’s vetoes. This change comes at a critical time when the state has just received a federal waiver to move Medicaid to managed care, resulting in massive changes to Medicaid as part of the largest procurement of private services in state history.
- In Montana, Medicaid expansion has been underway since 2015 resulting in enrollment for 129,000 low-income Montanans. However, according to Sarah Kliff, healthcare reporter at Vox, funding for Medicaid expansion in that state is scheduled to sunset this summer. Voters on Tuesday rejected a measure to raise cigarette taxes in order to continue to fund the expansion, which will now end later this year if the legislature doesn’t step in and provide more funding.
Ballot Measures Impacting Social Determinants of Health
There were more than 150 ballot measures being decided this Election Day, many of which impact health determinants in various ways:
- Criminal Justice: Voters in Washington State passed a ballot measure requiring mental health and de-escalation training for police officers, in an effort to reduce officer-involved shootings. Voters in Louisiana changed state law to require juries in felony trials to render unanimous verdicts, overturning a Jim Crow-era law that allowed 10 of 12 jurors to decide cases. Voters in Colorado outlawed involuntary servitude as a punishment.
- Cost of Living: Voters in Arkansas and Missouri voted to raise the minimum wage. Missouri’s wage rose to $12 from $7.85, and Arkansas’ increased to $11 from $8.50.
- Housing: Voters in San Francisco passed a plan to raise $300 million in corporate taxes in order to pay for homeless services, nearly doubling the amount spent annually. Californians also voted to approve statewide bonds to fund veteran and affordable housing, and voted to amend an existing housing program for people with mental illness.
- Transgender Rights: Transgender people face numerous health disparities as well as stigma, discrimination, and lack of access to quality care. In Massachusetts, voters rejected a referendum that would have repealed a 2016 law that prevents discrimination in public spaces, including bathrooms and locker rooms, based on gender identity.
Cannabis LegalizationMedical marijuana is currently legal in 31 states and the District of Columbia, and 9 states and the District of Columbia currently allow adults to buy and possess marijuana for recreational use.
- Voters in Missouri and Utah approved ballot measures to legalize medical marijuana in their states.
- Michigan became the first Midwest state to legalize recreational marijuana, while voters in North Dakota decided not to.
Health Policy Votes
- In Maine, voters rejected a measure that would have increased taxes to fund care for elderly people in their homes. By raising taxes on people with higher incomes, the measure would have generated about $310 million a year to pay for in-home care for all people 65 and over.
In Massachusetts, voters rejected a measure to set limits on the number of patients that can be assigned to a nurse. Hospitals opposed the measure arguing that it would increase medical costs and reduce staffing flexibility.
- Californians voted to approve statewide bonds for children's hospital construction, but voted to reject new regulations on kidney dialysis treatment charges.
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