The States Tackle Health Care Reform

The Trump administration has been working to weaken Obamacare, while the GOP-run Congress continues to look for ways to defang or undo the controversial health care law entirely. But while the battle rages in the political arenas, states are taking a more practical approach, writing their own rules to expand health care to their constituents.

From expanding Medicaid to covering birth control and making sure people with pre-existing conditions aren't priced out of the market, both blue and red states are going their own ways, according to an assessment by the nonpartisan group United States of Care. And while the policy approaches differ, governors and state legislatures across the country are coming around to a common truth: waiting around for Washington to fix health care is a fool's errand, so state governments need to step up and do what they can for their own residents.

"Our position is, we're really not going to let Trump decide the fate of health care in our state," says Ray Castro, health policy director for New Jersey Policy Perspective, a progressive group, discussing a proposal in New Jersey to cover more children – including undocumented immigrants – in the Children's Health Insurance Program. "We're going to take it in our own hands. We really can't rely on Washington anymore. We have to chart our own path."

After an initial pushback in some red states, more states overall are expanding Medicaid, the federal-state program for the poor and disabled. In 2013, the year after the Supreme Court ruled that states were not required to expand the program under the Affordable Care Act, 26 states had adopted Medicaid expansion. As of today, that number has grown to 33 (plus the District of Columbia). Three traditionally conservative states – Utah, Nebraska and Idaho – have Medicaid expansion ballot initiatives this fall, while a fourth, Montana, will have a referendum on whether to continue the state's expanded Medicaid program past 2019 and tax tobacco to pay for it.

In Ohio, Republican gubernatorial nominee Mike DeWine, who had opposed Medicaid expansion, recently announced he supports it (though with work requirements for many recipients). His switch indicates that public opinion in a state which voted for Donald Trump for president has evolved on a law that has divided Democrats and Republicans deeply since its passage in 2010.

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