Medicaid expansion's new life

Republican-led states that have resisted expanding Medicaid for more than a decade are showing new openness to the idea. Driving the news: In the decade-plus since the landmark Affordable Care Act was enacted, 12 states with GOP-led legislatures still have not expanded Medicaid coverage to people living below 138% of the poverty line (or nearly $19,000 annually for one person in 2022). But there's evidence that the political winds are changing in holdout states like North Carolina, Georgia, Wyoming, Alabama and Texas, as leaders court rural voters, assess new financial incentives and confront the bipartisan popularity of extending health care coverage. Why it matters: Medicaid expansion, a key component of the Affordable Care Act, means increasing access to federal health insurance coverage for low-income residents, in exchange for a 10% state match of the federal spending.

Experts say it expands access to care, lowers uninsured rates and improves health outcomes for low-income populations. More than 2 million Americans would gain coverage if the 12 states expand Medicaid, according to a 2021 estimate from the Kaiser Family Foundation. The big picture: Some Republican states have already expanded Medicaid through executive authority or — in states where it’s legal to do so — citizen-led ballot initiatives. Referendums on the issue passed in Nebraska, Utah and Idaho in 2018 and Missouri and Oklahoma in 2020. Medicaid expansion is on this November's ballot in Republican-controlled South Dakota. (Voters there in June rejected a GOP proposal to make it harder to pass.) Be smart: In most of the remaining non-expansion states, neither ballot initiatives nor executive authority are options, leaving the legislature with the authority to make the decision. State of play: In Georgia, as first reported by Axios Atlanta, conversations about a path forward have been taking place behind the scenes in both parties. This follows the stunning support of full expansion legislation by North Carolina's top Republican this spring, first reported by Axios Raleigh.