ObamaCare on the ballot: Medicaid expansion likely to hit state ballots in 2022 – and here’s the price tag

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A key element of the ObamaCare law could hit ballots in at least four states – including the bellwether state of Florida – in 2022, which would be one-third of the non-expansion states.

Mississippi, South Dakota and Wyoming also face state constitutional amendments on the ballot to expand Medicaid, the joint federal-state health care program for the low income. In recent years, Medicaid ballots initiatives prevailed by the narrowest of voter margins after state legislatures rejected the idea as too costly.

If these four states expand Medicaid, it would expand their budgets by a total of $163.3 billion—$128 billion from Florida alone—over the next 10 years, according to an analysis by fiscal watchdog group Foundation for Government Accountability, released last week. It would also add another 2.4 million able-bodied adults to the Medicaid roles and increase hospital costs by $760 million in those states the report says. The FGA analysis adds that 85,810 individuals—71,662 from Florida—are already on Medicaid waiting lists in these states.

“We are looking at expanding the Medicaid rolls during a waiting-list crisis when tens of thousands of people with chronic conditions and severe disabilities have died waiting to have Medicaid coverage,” Hayden Dublois, research analyst with the Foundation for Government Accountability and a co-author of the report, told Fox News.

Since 2014, after the initial implementation of the Affordable Care Act, better known as ObamaCare, most state legislatures took the additional federal dollars and expanded Medicaid to go to up to 138 percent of the federal poverty level, or $30,000 for a household. Previously the federal program was only available to 100 percent of the poverty level.

However, after many states blew past projected enrollments and cost estimates, and hospitals became ill-equipped to provide care, state lawmakers put on the breaks and rejected expansion. Enter the move to have voters do it directly.

“The impact is that elected officials who have access to information and are aware of the ancillary benefits weighed against the fiscal costs are cut out of making this decision,” Dublois said.

In Florida, 8% of voters from the previous election have to sign a petition for a proposed constitutional amendment to qualify for the ballot, which would reportedly be 891,589 signatures.

Expansion advocate Florida Decides Healthcare asserts adding 800,000 Floridians to Medicaid would be an economic boon and actually a cost-saver.

“The increased demand for health services would create thousands of new jobs in Florida, and the new money spent in our state would boost our economy, benefiting businesses and Florida residents alike,” the Florida Decides Healthcare website says.

The group’s website adds: “Instead of focusing on preventative care that saves both lives and money, we pick up the bill for people who have no ability to pay once their medical condition has become life threatening and more difficult to treat. The cost of this uncompensated care in our emergency rooms is passed along to taxpayers through state and local government programs and to consumers through higher insurance premiums.”

Florida Decides Healthcare did not reply to inquiries from Fox News for this story.

The FGA analysis projects 1.9 million new enrollees in Florida and estimates the hospital Medicaid shortfall in Florida would be $727.9 million.

Of the states, Mississippi would see the next largest impact, with 13,510 on the state waiting list, the expansion would add another 358,000 at an estimated cost over the next decade of $28 billion, according to the FGA report.

South Dakota would see an increase of 68,000 on Medicaid, with a estimated 10-year cost of $4.1 billion, according to the FGA report that predicts Wyoming would see Medicaid enrollees balloon by 42,000 costing $2.7 billion over the next decade.

The group, Dakotans for Health, which is circulating a petition, says Medicaid expansion, “will deliver healthcare to those who need it but can’t afford it, including many parents, seniors, and hardworking folks who earn less than $17,000 a year.”

“It will also bring more than $300 million of our tax dollars home from Washington, D.C., every year that will make it possible to provide health insurance to the uninsured, protect our rural hospitals, boost our economy, and create thousands of new jobs,” the South Dakota group adds.

Recent successful ballot initiatives in red states to expand Medicaid came after closely contested elections, the FGA report notes, in which activists turned out the vote in the most densely populated regions.

These narrow victories and a lack of statewide consensus is an even bigger reason Dublois says ballot initiatives “hijack the legislative process.”

In 2020, voters in 107 out of 116 Missouri counties and major cities rejected Medicaid expansion, but prevailed because more than one-third of all votes in the state in favor of expansion came from the St. Louis area.

Similarly, last year in Oklahoma, Medicaid expansion won by less than 1% despite losing in 70 of the state’s 77 counties. Of the seven counties that voted for expansion, a majority did so with fewer than 2,000 votes.

In 2018, voters in 84 of Nebraska’s 93 counties opposed expansion, but expansion still narrowly won.

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