Idaho, Nebraska and Utah Vote to Expand Medicaid

WASHINGTON — Voters in Idaho, Nebraska and Utah on Tuesday were on track to approve what their Republican-led legislatures repeatedly would not: free or low-cost health coverage for most poor adults through an expansion of their Medicaid programs. The three deep-red states are now poised to join 33 others that have already expanded Medicaid, an option under the Affordable Care Act since 2014.

In Montana, where the legislature expanded the program in 2015, but only for four years, voters appeared to reject a plan to sharply raise the cigarette tax to pay the state share of the cost. Expanded Medicaid will now end there, unless the legislature agrees on another funding source. The tobacco industry poured more than $17 million into ads opposing the tax hike.

The success of the citizen-driven initiatives in the three other states reaffirms the outsized role of Medicaid in expanding access to health care in the Obamacare era. In all, enrollment in the program has grown by at least 15.6 million, or 28 percent, since 2013, the year before the health law’s main provisions took effect. If lawmakers in Utah, Idaho and Nebraska don’t interfere — as happened in Maine, where Gov. Paul LePage has blocked an expansion of Medicaid ever since voters approved it last year — an estimated 325,000 people in the three states will be able to enroll in Medicaid starting next spring.

In Maine, where Mr. LePage is leaving office because of term limits, the Democratic candidate, Janet Mills, won. She wants to immediately move forward with expanding Medicaid to at least 70,000 low-income adults there.

Prospects for expanding Medicaid also improved in Kansas, where Laura Kelly, a Democrat who supports doing so, won the governor’s race Tuesday, and Wisconsin, where Tony Evers, the Democrat, defeated Gov. Scott Walker. The Republican-controlled state legislature in Kansas voted last year to expand the program, but former Gov. Sam Brownback vetoed the bill.

In Georgia, Stacey Abrams, the Democratic candidate for governor who made expanding Medicaid a top priority, trailed her Republican opponent but was hoping for a runoff. The governor’s race in another state with a large uninsured population, Florida, went to the Republican candidate, Russ DeSantis, making expansion unlikely there any time soon.

Opinion polls found broad support for Medicaid expansion in the three states where voters approved it Tuesday — as well as nationally suggesting its popularity now cuts across party lines. In all three states, governors and candidates for governor had said they will accept whatever outcome the voters decide.

The biggest reason Republican lawmakers have opposed Medicaid expansion is concern that it will eat up too much of the state budget. In a number of states that have already expanded the program, enrollment has far exceeded expectations, driving up costs. But under the terms of the health law, the federal government pays at least 90 percent of the costs for the newly eligible adult population.

In Nebraska and Idaho, the ballot initiatives did not include a way to pay the state share of expansion costs. That could potentially make them vulnerable to the type of stalling that’s happened in Maine, where Mr. LePage has grounded his resistance in the fact that the initiative did not include a funding mechanism.

In Utah, the measure increases the state sales tax rate on items other than food to 4.85 percent, from the current 4.7 percent, to pay the state share.

The largest donor overall to the Medicaid ballot initiatives was the Fairness Project, an advocacy group backed primarily by a California labor union. The group spent more than $5 million on signature-gathering efforts, advertising, field offices and other efforts.

“This election proves that politicians who fought to repeal the Affordable Care Act got it wrong,” said Jonathan Schleifer, executive director of The Fairness Project. “Expanding access to health care isn’t a blue state value or a red state value; it’s an American value.”

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