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Ever since the SCOTUS made Obamacare's expansion of Medicaid (effectively turning it into a universal coverage program for low-income Americans for the first time) optional for states, each state has had to make the choice of whether to take up the option to do so. Most jumped at the chance, not least because the federal share of the financing for Medicaid expansion--90% of costs--is much higher than it's historically been for Medicaid. And over the years even those states that initially held out have opted to expand, either due to leadership changes or, in the case of some deep red states, the voters stepping in directly via ballot initiatives to overrule recalcitrant legislatures.
So now we're down to the final twelve.
My unscientific, guesstimated likelihood tiers:
The strong possibilities.
South Dakota. This will go before the voters this November, and (other than in Montana, where Medicaid was already expanded anyway), Medicaid expansion has never failed at the ballot box, even in incredibly deep-red states.
Legislature leaving Medicaid expansion in hands of South Dakota voters
Wyoming. Wyoming has increasingly been flirting with expanding; its state House even passed expansion last year, though it didn't become law. There's some attempt right now to get it down via the state's budgeting process and that will be interesting to watch.
Medicaid expansion in Wyoming is dead again. Or maybe not.
The "it could if everything breaks just right" states.
Georgia. Obviously this state has been trending blue, but it looks like they'll need some changes in leadership after the November elections to get this done.
Ga. voters will decide the next governor and the state's status with Medicaid
North Carolina. They've got a blue governor and growing Republican legislative support but will it be enough? Apparently they're (maybe) going to give the issue a vote this year so we'll see.
NC GOP: Medicaid expansion vote possible later this year
Florida. This is another state where Medicaid expansion can happen via ballot initiative, but I haven't heard much about the prospects for that this year lately. But a FoxNews article this week tells me it's still on the table for this election cycle, so okay.
ObamaCare on the ballot: Medicaid expansion likely to hit state ballots in 2022 – and here’s the price tag
The "it's probably going to take a while" tier.
Kansas. They've got a blue governor who ran on expanding Medicaid, and it looks like there's some effort at a legislative push now. Which is better than nothing, but how much better?
Long-promised Medicaid Expansion bill introduced in Kansas legislature
Mississippi. Their prospects looked brighter before the state's Supreme Court invalidated their entire ballot initiative process after voters approved a medical marijuana initiative in 2020. Now their hopes rest on their legislature doing something on the issue.
Renewed push for Medicaid expansion in Mississippi
Alabama/South Carolina/Tennessee/Texas/Wisconsin. Don't hold your breath.
Anyway, it took 17 years from the passage of the original Medicaid program for the last state to opt-in. So counting from the 2014 start of the Medicaid expansion, it'll be 2031 before we hit that point for the expansion. In the meantime, lots of people in those holdout states will continue to lack access.
So now we're down to the final twelve.
My unscientific, guesstimated likelihood tiers:
The strong possibilities.
South Dakota. This will go before the voters this November, and (other than in Montana, where Medicaid was already expanded anyway), Medicaid expansion has never failed at the ballot box, even in incredibly deep-red states.
Legislature leaving Medicaid expansion in hands of South Dakota voters
Wyoming. Wyoming has increasingly been flirting with expanding; its state House even passed expansion last year, though it didn't become law. There's some attempt right now to get it down via the state's budgeting process and that will be interesting to watch.
Medicaid expansion in Wyoming is dead again. Or maybe not.
The "it could if everything breaks just right" states.
Georgia. Obviously this state has been trending blue, but it looks like they'll need some changes in leadership after the November elections to get this done.
Ga. voters will decide the next governor and the state's status with Medicaid
North Carolina. They've got a blue governor and growing Republican legislative support but will it be enough? Apparently they're (maybe) going to give the issue a vote this year so we'll see.
NC GOP: Medicaid expansion vote possible later this year
Florida. This is another state where Medicaid expansion can happen via ballot initiative, but I haven't heard much about the prospects for that this year lately. But a FoxNews article this week tells me it's still on the table for this election cycle, so okay.
ObamaCare on the ballot: Medicaid expansion likely to hit state ballots in 2022 – and here’s the price tag
The "it's probably going to take a while" tier.
Kansas. They've got a blue governor who ran on expanding Medicaid, and it looks like there's some effort at a legislative push now. Which is better than nothing, but how much better?
Long-promised Medicaid Expansion bill introduced in Kansas legislature
Mississippi. Their prospects looked brighter before the state's Supreme Court invalidated their entire ballot initiative process after voters approved a medical marijuana initiative in 2020. Now their hopes rest on their legislature doing something on the issue.
Renewed push for Medicaid expansion in Mississippi
Alabama/South Carolina/Tennessee/Texas/Wisconsin. Don't hold your breath.
Anyway, it took 17 years from the passage of the original Medicaid program for the last state to opt-in. So counting from the 2014 start of the Medicaid expansion, it'll be 2031 before we hit that point for the expansion. In the meantime, lots of people in those holdout states will continue to lack access.
