Democrats look to states to expand Medicare coverage

Democrats’ plans for “Medicare for all” are likely to stall in a divided Congress, leaving liberal activists looking to the states in 2019, hoping newly elected progressive champions will try to push the boundaries beyond Obamacare.

Capitol-watchers in California are waiting to see if Gov.-elect Gavin Newsom can fulfill his campaign push for sweeping, single-payer system.

In New Mexico, meanwhile, Democratic Gov.-elect Michelle Lujan Grisham is breathing life into the idea of a “Medicaid buy-in,” in which uninsured residents pay a share of premiums to enter the insurance program for low-income Americans.

And in Colorado, Gov.-elect Jared Polis, a Democrat, ran on a plan to reform health care within 100 days. He wants to consolidate insurance rating zones into one statewide one, so rural parts of the state see lower premiums, and provide seed money for clinics in isolated areas. The state is also studying the potential benefits of a Medicaid buy-in plan.

“I think 2019 will hatch some of the ideas in states that could end up becoming great models for federal policy,” said Andy Slavitt, who oversaw public insurance programs during President Obama’s second term.

Health care was a major issue in November’s elections, and Democrats say it propelled them to reclaim the majority in the House. It’s not clear whether it was as crucial to state governor and assembly races, but the elections still saw some vociferous advocates of expanded government involvement in the health markets win their races.

Ms. Lujan Grisham, for example, campaigned on her expansion of Medicaid to people beyond the current limits and state Sen. Gerald Ortiz y Pino said he plans to offer a bill in the coming session, which starts Jan. 15, that could extend coverage to up to 50,000 residents.

He would use state funding to assist workers who have job-based insurance but still struggle to pay for children or other dependents; people who make above 200 percent of the poverty level and feel Obamacare’s subsidies aren’t good enough; or immigrants who don’t qualify right now for federal assistance.

The senator said the price tag of up to $50 million in state funding is “hefty,” but an oil boom in southwest New Mexico is putting money in the budget and Ms. Lujan Grisham pledged during the campaign to leverage “every dollar, especially from Medicaid, to create a sustainable health care system for all New Mexicans.”

“New Mexico is a wonderful state, but unfortunately we end up on the bottom of lists that aren’t great, such as a high poverty rate or low child well-being,” said Abuko Estrada, who works on health care issues for the New Mexico Center on Law and Poverty. “For us to be on the top of something that is innovative and helps our residents get healthcare coverage is something very special to us.”

Money remains the sticking point in California, which rejected a single-payer bill earlier this year because the price tag reached $400 billion.

Mr. Newson, a Trump critic who defeated Republican John Cox last month, has tamped down expectations around the single-payer vision he campaigned on, saying it may take “years” to implement.

Indeed, experts say it would be hard for the state to pay for it on their own without buy-in from the Trump administration, which prefers free-market health reforms instead of an expansion of government.

“Any plan for expansion is going to be dependent on those budget numbers,” said David McCuan, a politics professor at Sonoma State University. “The ability to deliver and pay for single payer is still going to be a pipe dream.”

While some governors are on offense, others see their biggest test as playing defense to preserve Obamacare’s gains.

Maine Gov.-elect Janet Mills, a Democrat who defeated Republican Shawn Moody in November, is set to expand Medicaid coverage to able-bodied people whose incomes are slightly above the poverty level.

State voters approved an expansion plan on the 2017 ballot, though Republican Gov. Paul LePage thwarted its implementation for over a year, saying the legislature failed to fund the state’s share of the plan.

In Wisconsin, Gov.-elect Tony Evers vowed to withdraw the state from a lawsuit that says Congress’ decision to gut Obamacare’s individual mandate made the rest of the program unconstitutional, including protections for people with pre-existing conditions. State Republicans and departing Gov. Scott Walker approved lame-duck bills that will make it difficult for him to follow through, however.

Mr. Evers recently vowed to protect sicker residents one way or another — perhaps a state plan — if the courts upheld a federal judge’s Dec. 14 ruling in the suit that went against Obamacare.

For its part the Trump administration is encouraging states to experiment with Obamacare by applying for waivers to implement ideas that can expand coverage at the same cost, or cover the same people for cheaper.

Yet the suggested menu of options the administration released did not include the big-government ideas that liberal groups prefer.

“We need to be aware that some versions of expanding coverage actions may require federal approval,” said Adam Fox, director of strategic engagement for Colorado Consumer Health Initiative, which is studying ways to expand coverage. “And based on recent changes to federal guidance, that may be more challenging than it would have been a year ago or under a different administration.”