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A Wave Election for Health-Care Reform

Red-state voters grew tired of waiting for their legislatures to expand access to insurance.

A Wave Election for Health-Care Reform

Red-state voters grew tired of waiting for their legislatures to expand access to insurance.

Utah wants more Medicaid.

Photographer: George Frey/Getty Images
Photographer: George Frey/Getty Images

After an election campaign centered largely on health care, voters delivered their most emphatic message on the issue — not to Congress, but to the governments of red states. Expand Medicaid to cover a bigger share of the low-income population.

For years, the people of Idaho, Utah and Nebraska watched their legislatures stubbornly refuse to widen Medicaid coverage as Obamacare proposed — forfeiting, in the process, billions in federal aid. On Tuesday, they took matters into their own hands, passing ballot initiatives to end the nonsense. In three more states — Maine, Kansas and Wisconsin — voters elected Democratic governors who promised to push for the same.  

Thus, the 2018 election stands to provide hundreds of thousands more Americans access to Medicaid. That counts as significant progress toward health-care security in the U.S.

It had never made sense for these states — or any of the others that have yet to expand Medicaid — to refuse to bring low-income childless adults into the program when the Affordable Care Act enabled them to do so, starting in 2014. (The original Medicaid population includes poor children, pregnant women and people with disabilities, whose eligibility varies from state to state.) With or without Medicaid, taxpayers end up paying when poor people can’t afford health care. Medicaid provides an efficient way of doing so.

Defiant Republican legislators and governors have argued that expansion is unaffordable. Yet most states that have participated in the expansion have seen only positive effects: improved access to medical care and financial security among low-income populations, and less need for hospitals and doctors to provide care without payment. And access to Medicaid hasn’t discouraged the newly eligible from working, as some critics had warned it would.

Many state leaders have simply recoiled from cooperating with anything connected to Obamacare. Voters wisely view health care in a less partisan light. Their growing attachment to the Affordable Care Act probably handed Democrats control of the U.S. House of Representatives on Tuesday.

Citizens of the other states whose governors and legislatures have blocked Medicaid expansion may want to consider ballot measures of their own in 2020. It’s the fastest way to make progress toward universal health-care coverage — a compelling goal for the country as a whole.

    —Editors: Mary Duenwald, Clive Crook.

    To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at .

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