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Wednesday, April 11, 2018


Expand Medicaid, expand the electorate

by Tom Sullivan

Status of State Action on the Medicaid Expansion Decision, via Kaiser Family Foundation.

Expanding Medicaid where it has been denied might be good motivation for voters going to the polls in the mid-term elections this fall.

Progressives hoping to win back state legislatures and the U.S. Congress will not get there by winning only in places they are accustomed to competing. Aversion to the sitting president mounts and energy seems to be on the side of Democrats, but they still need more than "not Trump" to win in the mid-term elections. Health care costs are on everyone's mind and will be a central issue.

Some activists in rural America are working to put health care itself on the 2018 ballot. Luke Mayville and Garrett Strizich are driving around Idaho in a bright green camper with “Medicaid for Idaho” painted across the side (via Mic):

Like many red-state progressives, Mayville and Strizich have been emboldened in the Trump era to channel the recent wave of grassroots organizing into progressive electoral victories in conservative territories. They believe Medicaid may be the key to turning deeply conservative states like Idaho into hotbeds for progressive politics.

In July, Mayville, Strizich and his wife, Emily Strizich, co-founded a group called Reclaim Idaho, an organization devoted to pushing Idaho’s politics left. In the fall, they launched their Medicaid for Idaho ballot initiative, driving a bright green “Medicaid Mobile” van across Idaho to spread their message and gain support.

“We think that ultimately, the politics of Idaho will only change if a lot of new people come into the process — especially younger voters and working people of all different backgrounds who have tended to sit out of midterm elections, and only vote for big presidential elections,” Mayville said in an interview with Mic. “Medicaid expansion is exactly the kind of policy that will really draw them out. So much is at stake in whether or not they vote, and we intend to make that very clear.”

The effort has imitators in Utah and Nebraska and echoes a successful ballot initiative in Maine last November to expand Medicaid in a state where Gov. Paul LePage (R) led the opposition. Question 2 passed in Maine by 59 to 41 percent.

States with initiative or referendum, via Ballotpedia.

But only half the states allow ballot initiatives. Of the 18 states that have withheld Medicaid expansion, half have no process similar to Maine's. Progressive activists hoping to expand Medicaid in states like Texas, North Carolina or Wisconsin will have to retake their state legislatures from Republican control and remove recalcitrant governors like LePage. (North Carolinians replaced theirs in 2016.)

What better reason to get out and vote this fall?

Mic reported in February that expanding Medicaid has widespread support even in most red states:

Polling and surveys consistently show strong support for Medicaid expansion across the country, even in some of the most conservative states. An analysis of survey data provided exclusively to Mic by the progressive data science group Data for Progress found that support for Medicaid expansion exceeds opposition in all but one state — Wyoming.

“Our model fits well with state-level surveys, which show strong support for Medicaid expansion, even in deep-red states such as Kansas, South Dakota and Georgia, where support for rejecting expansion is at 41%, 42% and 43% respectively,” Data for Progress co-founder Colin McAuliffe said in a statement. “For reference, Gov. Ralph Northam (D-Va.) successfully ran a pro Medicaid expansion campaign in Virginia, where public opposition to expansion (42%) is comparable to these redder states,” he added.

Evidence suggests putting Medicaid expansion on the ballot has the potential to drive turnout and alter the electorate. For example, after Maine voters put Medicaid expansion on the ballot in 2017, officials across the state reported higher-than-expected turnout for an election that did not include any statewide or national races.
There will be much discussion of the president's multitudinous foibles this summer, but what voters want are direct improvements to their lives. While the Affordable Care Act has worked well for many, Americans in states that have stonewalled fully adopting it remain vulnerable.

Organizers of the renewed Poor People's Campaign have made Medicaid expansion central to their effort to address poverty and injustice in America. Rev. William Barber II told Huffington Post, "When you look at all the states that denied Medicaid expansion, the majority of those people who got hurt were white — mostly in the South and in the Rust Belt."

Just don't label them poor. It's not how they wish to identify.

In Wheeling, West Virginia, Amy Jo Hutchinson feels vulnerable every day:
Hutchison, 46, is the single mother of two daughters, ages 14 and 11. She's on Medicaid, and her daughters are enrolled in the Children's Health Insurance Program, which provides low-cost coverage. She has a full-time job and a bachelor's degree. And she's white.

"People perceive me as solidly middle class," said Hutchinson, who lives in Wheeling and is one of the campaign's leaders in West Virginia. But she describes herself as living on the "high end of poverty."

"There's never a month when two flat tires wouldn't cripple me," she said in a phone interview Monday.
Health Care costs are a significant contributor. Across a wide swath of America, people feel government doesn't work for them any more. The source of that feeling is not just in D.C., but in state capitols. Mayville and Strizich are literally driving home that point in Idaho and giving voters there a reason to engage and vote in November. Perhaps progressive candidates elsewhere will give voters a better reason to turn out this fall than #NeverTrump.

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For The Win 2018 is ready for download. Request a copy of my county-level election mechanics primer at tom.bluecentury at gmail.