Michael Hiltzik: Obamacare had a very good day at the polls, even as Trump officials stepped up their attack on the program

Michael Hiltzik, Los Angeles Times on

Published in Business News

Republicans who think the American public is clamoring to repeal or roll back the Affordable Care Act have another think coming.

Voters in Maine overwhelmingly enacted Medicaid expansion for their state Tuesday, overturning a string of five successive vetoes by their right-wing governor, Paul LePage. The vote was roughly 60 percent-40 percent. Maine thus becomes the 33rd state (including the District of Columbia) to expand Medicaid under the Affordable Care Act, the first to do so during the Trump administration, and the first to do so by ballot initiative.

Expect more of the same in other states where the Republican political establishment has blocked expansion, including Utah and Kansas. LePage, by the way, has said he'll refuse to implement the policy mandated by Maine's voters, but he's sure to face a fight over his position.

The Maine result, which will bring health coverage to an estimated 80,000 residents, has other national reverberations. The state's senior Sen. Susan Collins, a Republican, has been a steadfast opponent of GOP efforts to repeal the ACA in Congress. She also has expressed distaste for the House GOP's idea to fold an Obamacare rollback into its tax cut measure. The vote back home will only strengthen her resolve; the chance she will change her mind now has to be counted at less than zero.

In Virginia, Ralph Northam was elected to succeed his fellow Democrat Terry McAuliffe as governor, which may mean a renewed push to expand Medicaid there. Northam will be helped by the apparent flip of the state's lower legislative chamber, the House of Delegates, from Republican to Democrat (four key seats are too close to call and require a recount). The state Senate remains narrowly Republican and won't be subject to election until 2019, but its GOP members may want to take a close look at their opposition to Medicaid if expansion comes before them again.

The election results suggest that the public strongly favors Obamacare in general and Medicaid expansion in particular. What's fascinating about that is that they came the very day that Trump's Medicaid administrator, Seema Verma, unveiled a new attack on Medicaid expansion that would almost certainly result in fewer enrollees.

Verma's attack, which came in a speech to the National Assn. of Medicaid Directors on Tuesday, was backed by some very misleading statistics and suspect assertions. They're worth examining in detail.

Verma's general theme was that simply enrolling more people in Medicaid wouldn't guarantee they'd get better care, and might even undermine the care provided to existing enrollees. Of the successful expansion of Medicaid rolls under the ACA, she said, "We will not just accept the hollow victory of numbers covered."

This is a remark of almost medieval stupidity. All the evidence available indicates that having coverage under Medicaid produces better health, including mental health, than the lack of coverage, as well as improved family finances. It's no "hollow victory" by any standard.

Verma depicted Medicaid as rife with "problems with access, problems with quality, and problems with program integrity." She observed that "more than 1/3 of doctors won't even see Medicaid patients."


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