Medicaid expansion scores big victory in 2019 elections

If Tuesday’s elections served as a referendum on health care — Medicaid expansions and work requirements were on the line in Virginia, Kentucky and Mississippi  — then a number of voters sent a clear message: They want expanded access to health care in their states.

In Kentucky, incumbent Republican Gov. Matt Bevin appears to have narrowly lost to his Democratic challenger, Attorney General Andy Beshear. Bevin has not conceded the race.

While in office, Bevin, a deeply unpopular governor, advocated for the state’s Medicaid work requirements, which forces some recipients of Medicaid to prove they have a job, go to school or are volunteers in order to receive their benefits. There are some exceptions for people who are ill or taking care of family members. However, the proposal was blocked in March by a federal judge. If the federal appeals court in Washington, D.C. also ruled against them, Bevin was expected to appeal to the Supreme Court.

He also threatened more than once to scrap the Medicaid expansion unless his state was allowed to move forward with the work requirement, insisting the new rule would shift some adults off the program so the state had enough money to help new enrollees.


But Beshear campaigned on defending the Medicaid expansion and, when claiming victory on Tuesday, vowed to roll back the work requirements during his “first week in office.”

“I ran on kitchen-table issues, and I will govern, focused on those same challenges of good jobs, health care for every Kentuckian, protecting and funding our pensions and always supporting public education,” he said.


The Obama-era Affordable Care Act initially expanded Medicaid, which provides health insurance for low-income people, to all residents whose income is less than 133 percent of the poverty line (that’s roughly $16,000 for one person, or about $32,700 for a family of four). But in 2012, the Supreme Court ruled that states did not have to adopt the expansion, diluting the policy. As of this year, 36 states and D.C. have adopted the Medicaid expansion.

According to Joan Alker, the executive director of the Georgetown Center for Children and Families, nine of the top 10 rural counties with adults on Medicaid (roughly 50 percent) are in Kentucky. In those areas, the total number of votes for Bevin dropped, she said.

"Fascinating and good night for Medicaid," she wrote in a tweet.

Democrats in Virginia also flipped the state legislature for the first time in more than two decades, meaning they now have majorities in the House and Senate, as well as a Democratic governor, Ralph Northam. That’s notable because Northam succeeded in expanding Medicaid last year, but was forced to concede some ground on work requirements to Republicans, who controlled both chambers at the time.

“Democrats have flipped the Virginia House and Senate, securing a legislative trifecta & with it can control redistricting, protect Medicaid expansion, institute universal gun background checks, and secure protections for LGBTQ people,” pollster Matt McDermott said in a tweet.

Of course, in Mississippi, Republican Lt. Gov. Tate Reeves won the state’s gubernatorial election. His victory puts an end to the possibility of Medicaid expansion and will likely closely align the state with the Trump administration’s agenda.

Medicaid expansion was one of the biggest differences between Reeves and his opponent, Attorney General Jim Hood. Hood made it clear during the campaign that if he were elected, he would bring health benefits to 100,000 uninsured Mississippians living in poverty.

“Jim Hood believes that every Mississippian should have the same access to healthcare,” Hood’s campaign said on its website. “Hundreds of thousands of Mississippians are without healthcare and Mississippi’s been shortchanged more than $5 billion simply because of petty, partisan politics.”

Reeves starkly opposed that expansion on “philosophical grounds.”