Insights

Medicaid has been a hot topic in previous elections – but is it in 2024?  The previous blog in our series on health care and the 2024 elections discussed the Affordable Care Act (ACA) and the 2024 election. Today’s post will focus on Medicaid expansion and the 2024 election.

Medicaid Expansion Has Grown Steadily

The ACA authorized the expansion of the Medicaid program to include working-age adults without children or disabilities. Although the Supreme Court ruled against mandating expansion, the battles over this policy did not end. They only shifted to the states.

• 25 states and the District of Columbia (D.C.) implemented Medicaid expansion as soon as possible (January 1, 2014).
• Michigan and New Hampshire waited until later in 2014.
• Pennsylvania, Indiana, and Alaska joined the ranks of expansion states in 2015.
• Montana and Louisiana jumped on board in 2016, and Virginia and Maine implemented expansion in 2019.
• Idaho, Utah, and Nebraska joined the list in 2020. Oklahoma implemented expansion in 2021, and Missouri began processing applications that same year.
• South Dakota and North Carolina implemented expansion in 2023 and are the most recent editions to the list. You can see how the number of Medicaid expansion states has grown by comparing the two maps below from 2013 and 2023.

These 2 charts show you the change.  Blue is yes to Medicaid expansion.  Orange is no to Medicaid Expansion.  See how the blue grows over the time period between 2013 and today.

Medicaid Expansion as of 2013:  25 States Plus DC

Medicaid Expansion in 2024:  35 States Plus DC

Big Growth, Big Political Implications

It’s worth noting that the growth in Medicaid expansion and the 2024 election intersect in a big way. As more states decide to expand Medicaid, the pathway to 270 electoral votes increasingly depends on appealing to voters who have gained health insurance coverage because of Medicaid expansion.

For example, let’s look at North Carolina. According to a press release from the North Carolina Department of Health and Human Services, more than 600,000 North Carolinians are now newly eligible for Medicaid coverage.

In 2020, North Carolina went for former President Trump, but his margin of victory was less than 100,000 votes. It begs the question of how many of these voters could flip to President Biden in 2024 and whether it could be enough to flip the state.

Even among more Trump-friendly states, the growth of Medicaid expansion could impact returns in 2024. For example, President Trump won 61.8% of the vote in South Dakota in 2020 with 261,043 votes compared to Biden’s 150,471. According to the U.S. Department of Health and Human Services, more than 52,000 South Dakotans can now enroll in Medicaid. Might more South Dakotans vote for Biden in 2024?  Maybe.  We don’t expect South Dakota, whose state government is redder than red to give Biden any votes in the electoral college.  South Dakota has not voted for a Democratic presidential nominee since 1964.  But post-election polling in November may provide some insight into how Medicaid expansion played into voters’ behavior this year.

What, if any, implications are there in states that have not expanded Medicaid. Interestingly, the Kaiser Family Foundation conducted a poll in March 2023 showing that two-thirds of residents in non-expansion states are supportive of expansion.

Where Do the Candidates Stand?

Biden is Pro-Medicaid

• President Biden strongly supports the ACA, including the Medicaid expansion provision.
• The president included language in his proposed budget for fiscal year 2024 calling for “Medicaid-like coverage” for those who live in states that have not expanded Medicaid.
• The president’s budget proposal also called for “financial incentives to ensure states maintain their existing expansions.” President Biden’s decision to include these provisions in the proposal shows his strong support for getting all states to adopt Medicaid expansion.
• President Biden continues to highlight his record on protecting and expanding Medicaid in contrast to former President Trump.

Where is Trump on Medicaid?

• Meanwhile, Former President Trump has not yet talked much about Medicaid expansion in his 2024 campaign. However, we can look at his time in office to see what we might expect if he won reelection.
• In 2020, the Trump Administration offered a demonstration program they argued would provide more flexibility to states in providing benefits to working-age adults without disabilities. However, critics of the plan, such as Senator Tim Kaine (D-VA), charged that it threatened the health care of the Medicaid expansion population.
• The Trump Administration also supported allowing states to impose work requirements on the Medicaid expansion population. Vox Senior Correspondent Dylan Scott argued at the time that these policy changes were part of an effort to undo the expansion of Medicaid under the ACA.

Medicaid Expansion and the 2024 Elections

President Biden and former President Trump have a record regarding policies related to Medicaid expansion. As the list of Medicaid expansion states grows, so does the importance of how the leading presidential candidates talk about this issue. Ultimately, it will be up to the candidates to decide how much to talk about the issue of Medicaid expansion and what to say. And, of course, the American people have the final say. As Alexander Hamilton put it, “Here, sir, the people govern; here they act by their immediate representatives.”

NC Medicaid Expansion to Launch on Dec. 1

Medicaid expansion is set to kick off in North Carolina on December 1, 2023, marking the end of a decade-long effort to use federal dollars to expand coverage for low-income residents.  The North Carolina Department of Health estimates up to 600,000 people will be eligible for Medicaid coverage.  Adults ages 19-64 earning up to 138% of the federal poverty line (about $20,000 for an individual and less than $34,000 combined for a family of three) may be eligible.   North Carolina Republicans used their veto-proof majority in the state’s General Assembly to make Medicaid expansion a reality by including it in a budget bill laden with other GOP priorities, much to the chagrin of Gov. Roy Cooper (D).

Deloitte: Women Pay $15B More on Health Care Each Year

Women pay $15 billion more on out-of-pocket health care costs annually compared to men, according to a new study by Deloitte.  Among the factors attributed to the so-called “pink tax” are the high cost of breast cancer imaging compared to screening for other cancers, the frequency of gynecological exams, and earlier age recommendations for annual checkups compared to men. The study’s authors examined the medical spending of 16 million American workers with employer-sponsored health plans from 2017 through 2022.  To help cut costs, experts recommend addressing as much as possible during annual checkups to limit the need for follow-up visits.

GAO: 5% of Nursing Homes Owned by Private Equity

Five percent of the nation’s 14,800 nursing homes are estimated to be owned by private equity, according to a report by the Government Accountability Office (GAO).  However, the report’s author noted that the 5% figure could be an underestimate because the Centers for Medicare and Medicaid Services (CMS) does not collect data on all nursing facility owners.  Another issue limiting the report’s findings is the fact that CMS does not present its data in a way that makes it easy to identify private equity firms.  The report’s comes amid growing calls for health transparency, as well as concerns that private equity ownership may affect health outcomes at nursing homes.   In February 2023, CMS proposed rulemaking that would nursing homes to provide more information about their ownership.

Cambridge, Dallas Tapped as ARPA-H Regional Hubs

The Advanced Research Projects Agency for Health (ARPA-H) has selected Cambridge, MA and Dallas, TX as the locations for 2 of its 3 “hubs” that will focus on different activities.  According to the agency, the Boston-area hub will focus on engagement with investors and entrepreneurs, while the Texas hub will focus on patient experience issues such as clinical trial diversity and improving health outcomes for all populations.  ARPA-H plans to announce later this year the specific location of its third and final hub in the Washington, DC metropolitan area, which will focus on supporting stakeholders.  Each of the hubs will connect with “spokes” to carry out research at existing facilities.  Created in 2023, APRA-H is intended to support high-risk, high-reward medical research that can deliver breakthrough treatments and cures.

ICYMI: Suits Return to the Senate

Senators voted unanimously on Wednesday to codify a business casual dress code for the Senate floor, reversing a decision by Majority Leader Chuck Schumer (D-NY) last week to end enforcement of the dress code.  Schumer’s decision was primarily aimed at Sen. John Fetterman (D-PA), who has regularly worn hooded sweatshirts and shorts around the US Capitol Complex since returning to the Senate after being hospitalized for depression earlier this year.  Both Schumer and Fetterman offered their support and cooperation on the resolution to reinstate the dress code’s enforcement shortly before Wednesday’s vote.

CMS Pauses Medicaid Redeterminations in Some States

The Centers for Medicare and Medicaid Services (CMS) has temporarily paused the Medicaid redetermination process in a dozen states out of concern that too many enrollees may be losing their coverage for procedural reasons. Since a number of states resumed Medicaid redeterminations on April 1, over 3 million enrollees have lost coverage. Nearly three-quarters of the disenrollments have been for procedural reasons, which include administrative or paperwork errors in the renewal process. In some states, CMS has even reinstated Medicaid coverage for tens of thousands of enrollees. CMS plans to release state-level redetermination data in the next few weeks, and the agency is working with at least a dozen other states to address issues with the redetermination process.

Study: Most Hospitals Not Fully Complying with Price Transparency Rules

Only 36% of 2,000 surveyed hospitals are in complete compliance with federal hospital price transparency rules, according to a study from Patient Rights Advocate. Additionally, 64% of hospitals reported having incomplete files, and 69% did not post usable files on their changes. However, the July study shows an improvement from the February 2023 study, which found 25% of hospitals to be in full compliance with the rule. Since January 1, 2021, hospitals have been required to make public their standard charges for items and services via a “consumer-friendly display” and a comprehensive, machine-readable format.

Majority of Americans Don’t Know about 988 Suicide Hotline

Over 85% of Americans can’t recall the new number for the national suicide hotline, according to a new YouGov poll. In contrast, 92% of Americans reportedly identified 911 as the correct number for emergency services. The polling comes just a year after the federal government revamped the National Suicide Prevention Lifeline and changed the number to 988 so that it would be easier for people to remember. Despite the low memory retention on 988, the hotline has seen its use climb since last year’s rollout, with a 33% percent increase in the combined number of calls, texts, and chats since May 2022. 988 engagement is likely to continue to grow, as the administration prepares to reach new communities by adding Spanish text and chat services.

FDA Approves First RSV Shot for Infants

The Food and Drug Administration (FDA) approved nirsevimab as the first drug to protect infants and toddlers from respiratory syncytial virus (RSV), the leading cause of hospitalization among babies under a year old in the US. Developed by AstraZeneca and Sanofi, nisevimab is not a vaccine – meaning instead of prompting the body to make antibodies, nisevimab includes antibodies that can bind to RSV and prevent it from infecting healthy cells. A Center for Disease Control and Prevention (CDC) advisory panel will meet on August 3 to discuss how the injectable antibody drug should be administered.

ICYMI: DC Native and Resident Joins “Love Island USA”

The fifth season of Love Island USA recently debuted, and one of this season’s contestants is 23-year-old Keenan Anunay, a Washington, DC native resident who still resides in the city. Currently a journalism major at Morehouse College in Atlanta, Keenan was initially paired off with Kay Kay, contestant from Texas who currently works as a travel nurse. Love Island USA season 5 airs this summer on Peacock.

CMS Proposes Greater Drug Price Transparency in Medicaid

A newly proposed rule from the Centers for Medicare and Medicaid Services (CMS) would require pharmacy benefit managers (PBMs) that contract with Medicaid to disclose the prices they pay for prescription drugs. The proposed rule is part of a Biden administration effort to boost price transparency by tamping down on spread pricing, which refers to the practice of charging health plans for prescription drugs more than what they pay the pharmacy and pocketing the difference. The proposed rule comes as House and Senate committees advanced legislation this month that would ban the practice. Another key provision of the proposed rule would provide CMS and states with a drug price verification survey to help federal and state officials better negotiate what Medicare pays for expensive drugs. The deadline for stakeholders to comment on the proposed rule is July 25, 2023.

Debt Default Looms as Lawmakers Depart for Memorial Day

Despite recent progress on debt ceiling talks in Washington, lawmakers left the Capitol for Memorial Day weekend without a deal being reached. Assuming members are provided 24 hours’ notice before a final vote, the soonest the House can take a vote on a debt ceiling measure is Tuesday night. According to Republican negotiator Rep. Garret Graves (R-LA), major progress has been made on spending caps and energy permitting, while discussions remain underway on work requirements and unspent COVID-19 aid. Even if the House approves a debt ceiling bill early next week, Congress may not be able to completely raise the debt limit until June 3-4, which runs rather close to the estimated default date.

Surgeon General’s Warning on Kids’ Social Media Use

Overuse of social media can harm the mental health and well-being of children and adolescents, according to a new advisory from US Surgeon General Dr. Vivek Murthy. While the advisory acknowledges that social media provides some benefits to kids, such as helping kids feel more accepted and providing an outlet for creativity, survey data shows that social media use is attributed to body dysmorphia, poor eating behaviors, social comparison, and low self-esteem. To help protect kids from the harmful effects of social media, the Surgeon General recommends that policymakers create age-appropriate safety standards, support digital literacy education in schools, require more data privacy protections, and require social media companies to share health-related data.

CDC: HIV Cases Drop among Young People

New HIV infections among people ages 13-24 dropped 34% between 2017 and 2021, according to data from the Centers from Disease Control and Prevention (CDC). Public health officials attribute the decline to new medications that prevent infections and improvements in HIV testing. However, the decline in infections was not equally reflected among all racial or ethnic groups, as Black/African Americans and Hispanics/Latinos ages 13-24 saw a much smaller decline in infections compared to White people in the same age range. To address these disparities, the CDC recommends increasing investment in HIV prevention programs, expanding access to HIV self-testing, and addressing social determinants of health.

FDA Approves Synthetic Opioid Reversal Drug

On Tuesday, the Food and Drug Administration (FDA) approved Opvee, a prescription nasal spray that can reverse overdoses of synthetic opioids like fentanyl. The Indivior-produced drug is the first nasal spray to treat opioid overdoses in adults and children over 12 years of age. According to the FDA, Opvee can reduce the effects of opioid overdoses, such as respiratory depression, sedation, and low blood pressure if administered quickly. Opvee is similar to Narcan, which the FDA approved for over-the-counter use in March 2023. While it remains unclear how the new nasal spray will be used differently from Narcan, an advantage of Opvee is that it is better suited to address fentanyl, which stays in the body longer than heroin and other opioids. Indivior expects to launch Opvee in October at the earliest.

ICYMI: Memorial Day Travelers Can Expect Lower Gas Prices

If you’re hitting the road for Memorial Day weekend, rejoice: the average price of a gallon of gasoline is $3.53, which is about a dollar lower than last year’s national average of $4.60. However, gas prices are still higher than they were pre-pandemic, and travel experts warn that a busy road travel season this summer could bump gas prices up higher.

KFF: Up to 24 Million Could Lose Medicaid Coverage

Between 8 and 24 million Americans could be disenrolled from Medicaid following the end of the COVID-19 public health emergency (PHE), according to a new analysis from the Kaiser Family Foundation (KFF). The PHE suspended the Medicaid redetermination process, which states use to determine eligibility for Medicaid coverage. KFF’s analysis drew on estimates from a recent survey of state Medicaid officials conducted with Georgetown University. The redetermination process, which started April 1, will vary across the states due to different policy choices state officials have made as well as a variation in state administrative structures. It remains unknown how many people who lose Medicaid coverage will transition to other health coverage or become uninsured.

FDA Approves New ALS Treatment

On Tuesday, the Food and Drug Administration (FDA) approved via the accelerated approval pathway a new drug called Qalsody for a rare form of amyotrophic lateral sclerosis (ALS). Developed by Biogen, Inc., the drug works to reduce levels of a blood protein associated with brain injury. Due to its accelerated approval status, Qalsody must undergo more research on its effectiveness in order to remain on the market. The FDA estimated there are fewer than 500 patients in the US with the form of ALS that the Biogen drug treats. According to Biogen, the drug could be available to ALS patients as soon as next week.

Kaiser Permanente to Acquire Geisinger to form New Nonprofit

Kaiser Permanente announced Wednesday plans to acquire Pennsylvania nonprofit hospital system Geisinger Health to form a new nonprofit value-based health care organization. Known as Risant Health, the new entity will operate independently from Kaiser Permanente’s care and coverage model. The acquisition of Geisinger’s is part of an overarching strategy at Kaiser Permanente to obtain similar nonprofit, value-oriented community-based health systems in the coming years. In a recent interview, the company said it plans to invest $5 billion into Risant over the next five years and expects to add half a dozen additional systems to the new organization. The acquisition follows a growing trend of hospital and provider consolidation as hospitals continue to face financial strain related to the COVID-19 pandemic.

CDC: Smoking Down while E-Cigarette Use Continues to Rise

A recent survey from the Centers for Disease Control and Prevention (CDC) paints a mixed picture on the state of tobacco use in the nation. Between 2020 and 2022, the percentage of Americans who reported they are smokers dropped from 12.5% to 11%. However, the e-cigarette use rose from 4.5% to 6% over the same period. While use of combustible tobacco such as cigarettes has declined in recent decades, e-cigarette use has steadily grown in recent years, particularly among teens and adolescents. According to the CDC, smoking is a major cause of preventable disease, disability, and death. The agency also says that 9 in 10 lung cancer deaths were caused by smoking.

ICYMI: A Look Back on Jerry Springer’s Career in Politics

While Jerry Springer, who died this week at age 79, is best-known as a talk show host, his time in politics is often overlooked. Shortly after graduating from law school, Springer took a job with Robert F. Kennedy’s presidential campaign in 1968. A year following a failed bid for Congress, Springer was elected to the Cincinnati City Council in 1971. In 1977, the city council elected Springer for a one-year term to serve as mayor due to an unconventional election system that has since been altered. Springer also sought the Democratic nomination for Governor of Ohio in 1982, and he considered running for US Senate in 2000 and 2004 before ultimately deciding to back out due to negative associations with his eponymous television show. Additionally, Springer considered joining the Ohio gubernatorial race in 2018, but he decided against it due to his age.