As Republicans struggle to convey a clear healthcare policy message following the blue wave from last year's midterm elections, some states and cities are leveraging the vote of confidence in an effort to try to expand access to services and espouse liberal initiatives across the country.
Unsurprisingly, deeply blue New York City is leading the way. Last week, Mayor Bill de Blasio unveiled an expansion of the city's already-ample health coverage, promising the local government would spend at least $100 million to make sure undocumented immigrants and other low-income, uninsured populations receive medical treatment.
Ostensibly, this program is already in place under the city's public health insurance option MetroPlus. But the new initiative, called NYC Care, will use the additional funds to conduct outreach to some 600,000 uninsured citizens and connect them to primary and specialty care, along with prescription drugs, hospitalization and mental health services.
NYC Care will be priced on a sliding scale to promote affordability, according to the press release, and will launch this summer in the Bronx before gradually scaling to the rest of the city by 2021. "Everyone is guaranteed the right to healthcare," de Blasio said in a Jan. 8 news conference announcing the plan.
But de Blasio failed to provide any details about how the city plans to fund the $100 million healthcare expansion, or how much enrollees would have to pay. It's uncertain how the new service offerings will affect NYC Health + Hospital's budget. The health system already depends on more than $2 billion a year in subsidies from the city government, mostly due to its coverage of the uninsured.
Also Jan. 8 in the Empire State, Gov. Andrew Cuomo announced $10 million in capital funding was available for an expansion of addiction treatment — a development of up to 40 residential treatment or withdrawal and stabilization beds.
On the other side of the country, California's governor is making a similarly liberal proposal. Immediately after taking office Jan. 7, Gov. Gavin Newsom outlined a sweeping expansion of the state's Medicaid program, called Medi-Cal.
Newsom's plan would cover young undocumented immigrants up to age 26 and increase subsidies for middle-class families. If it is approved by the Legislature, California would be the first state to cover undocumented immigrants younger than 26 through state-run insurance.
Newsom also announced a policy to require all Californians carry health insurance and create an individual mandate in the state to replace the removal of the Affordable Care Act's penalty for uninsured consumers beginning this year. He released his state budget Thursday, committing $260 million to the plan, along with using an estimated $500 million to be gained from the new mandate to help cover increased subsidies.
The governor also signed executive orders to create a new surgeon general position to look at health disparities and have his health department negotiate Medi-Cal prices on behalf of its 13 million beneficiaries.
In Washington state, Gov. Jay Inslee (a likely 2020 presidential contender) is proposing adding a public option healthcare plan to the state's insurance marketplace, purportedly to help combat the state's recent double digit premium increases and stabilize the exchanges. It also amounts to a first step toward universal healthcare, according to the governor and supportive state representatives.
High off of sweeping midterm victories, Colorado Democrats in control of both chambers of the General Assembly have proposed creating a public option healthcare plan that would be an insurance alternative available as early as this fall in the state's highest-cost areas. A House bill would expand the program statewide by next year.
Another Senate bill would let Coloradans import prescription drugs from Canada, and a second House bill aims to tackle transparency in hospital billing.
Georgia, a traditionally conservative state, is also analyzing two major healthcare initiatives in front of its legislative body. Lawmakers are considering whether to keep its Certificate of Need regulation, which critics say can insulate hospitals from competitors, and potentially instituting a Medicaid waiver to expand coverage but likely with elements like work requirements.
When it comes to Medicaid, 14 states have yet to expand even a little bit, including Deep South bastions like Texas and Alabama. Utah, Idaho and Nebraska all voted to expand in November's midterms, which also left Wisconsin and Kansas with new governors who support Medicaid expansion.
In Maine, former Gov. Paul LePage delayed a voter-sanctioned expansion for months, but now that Democrat Janet Mills is in office, she is moving quickly to implement the plan.
And Democrats in New Mexico, Minnesota, Nevada and Illinois are considering Medicaid buy-in programs.
These moves to expand healthcare access, likely inspired by the Trump administration's ongoing campaign against the ACA (along with pertinent legal threats), mark the beginning of a conflict that will likely consume the next few years of the 116th Congress.
The exact details of many of these moves are unclear. In some cases, like New York City, they seem to be merely an expansion for original programs. In others like California and Washington, they're more revolutionary.
What the recent liberal pushes for more comprehensive healthcare have in common is that they're openly deepening the political divide in America across geographic and party lines.
On the conservative end of the spectrum, a number of states are still pursuing work requirements in Medicaid. And, some states may use new flexibility from the Trump administration to implement ACA waivers to redirect premium subsidies to loosely-regulated short-term plans.— Larry Levitt (@larry_levitt) January 9, 2019