Health Care

More Red States Open Door to Obamacare

If Alabama, Kentucky and Louisiana embrace Medicaid expansion, others will inevitably follow.

Are you in, Alabama?

We had more significant hints last week that the Medicaid expansion under Obamacare will eventually be universal.

First, Democrat John Bel Edwards appears to be the solid favorite to defeat Republican David Vitter in a special election for governor of Louisiana on Nov. 21. Edwards favors the Medicaid expansion.

Second, incoming Kentucky Governor Matt Bevin, a Tea Party stalwart who ran against Obamacare, is talking about negotiating a deal with the federal government over changing Medicaid expansion, rather than simply ending it.

And a surprising one: Alabama, with a solidly Republican state government, is reportedly reconsidering its opposition to the expansion.

None of these results are certain yet. But they follow the general pattern. States with Democrats in charge accept the program. States with Republicans in charge have mixed records of adopting it. But once a state goes along with Medicaid expansion, it doesn’t go back on it even if a strongly conservative Republican is elected governor.

That means Medicaid expansion remains a one-way street, and eventually all 50 states will accept it. We’re already up to 30 states with Montana’s recent agreement to sign up. 

Medicaid expansion is crucial to the aim of the Affordable Care Act: to insure that everyone in the U.S. has medical coverage. The resisting states are the main reason that goal has not been reached yet.

Of course, battles over Medicaid won't end even when the last state signs on. Expect to see plenty of fights, at both national and state levels, about any number of issues: how the program is administered, how generous the benefits are, how doctors and hospitals are treated. States may negotiate for waivers to run the program as they see fit as long as certain standards are maintained, and that leaves plenty of room for variation. This is where Kentucky is probably headed, and perhaps Alabama as well.

So it sure looks as if every state is going to join, one way or another, at some point. And that’s a big victory for Obamacare.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

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