WASHINGTON (MCT) The three red states Idaho, Nebraska and Utah that bucked their own Republican legislatures last month and approved Medicaid expansion under the Affordable Care Act are likely to proceed, despite last weeks ruling by a federal judge in Texas that the entire federal health care law is unconstitutional.
Even in Montana, where voters last month defeated an extension of the temporary Medicaid expansion approved in 2015, legislative leaders predict that lawmakers will make the expansion permanent, since it is politically unpopular to take coverage away from people once it has been extended.
Voter-approved Medicaid expansion would extend health care benefits to 91,000 low-income people in Idaho, nearly 90,000 in Nebraska and 150,000 in Utah.
Its in statute, so theres no turning back on it, Nebraska state Sen. Adam Morfeld, a Democrat who has championed the plan, said in an interview Monday. The only way we turn back on this is because its repealed at the federal level. He said hes confident that wont happen.
If we didnt enact policy in our state because of pending court cases elsewhere, wed never enact policy, Morfeld said. There are lawsuits on just about every federal program.
Similarly, Utahs voter-approved Medicaid expansion is on track for swift implementation, according to Matt Slonaker, executive director of the Utah Health Policy Project, which supports the initiative. The states Medicaid director is days away from submitting a so-called state plan amendment implementing the expansion. And the federal government is expected to approve it well in advance of its April effective date.
We see no reason to think the court decision will slow down the process in any way, Slonaker said. This is a district court way down in Texas that is trying to be disruptive with very weak legal reasoning. Here in Utah, were all systems go.
In Idaho, a Medicaid expansion referendum passed with over 60 percent of the vote, and had the support of the Republican governor, Butch Otter. In Nebraska and Utah, Republican governors opposed the expansion.
With the three states added to the list, 36 states plus Washington, D.C., have now approved Medicaid expansion, likely adding pressure on the remaining states to do so.
Last Friday, U.S. District Judge Reed OConnor overturned the entire ACA, ruling that when congressional Republicans eliminated the penalty for Americans who do not carry health insurance as part of their broader tax overhaul, they invalidated the health law. In his 55-page opinion, OConnor pointed out that the U.S. Supreme Court in 2012 upheld the ACA based on the idea that Congress has the power to impose a tax on those without health insurance.
Without the penalty, OConnor argued, there is no tax, and therefore the law is unconstitutional. Legal analysts from both sides of the political spectrum have cast doubt on that logic, predicting the decision will be appealed. In the meantime, the ACA stays in place.
We remain optimistic that Americans have made it clear that they want to expand access to care, not shrink it, said Colin Diersing, a spokesman for the Fairness Project, which helped bankroll the four state ballot initiatives.
Montana voters defeated the Medicaid expansion ballot question this fall, but polls showed many were turned off by the idea of funding it with a tobacco tax; the tobacco industry spent mightily in opposition.
Nevertheless, Montanas Republican-controlled legislature will be taking up expansion bills in January, and every bill is expected to get a chance at a hearing and a vote.
The legislature is very divided on this issue, said Montana Senate President Scott Sales, a Republican. Although hes trying to learn more about what last weeks court ruling might mean, he said, Democrats and the moderate wing of his party together likely have the votes to pass an expansion, though conservatives will work to impose cost-control measures.
