Three deep red states voted to expand Medicaid, and a fourth voted in a governor who will comply with her state’s 2017 referendum results and do the same.

Joe Paduda

Four states — Montana, Utah, Nebraska and Idaho, all consistently Republican — had Medicaid expansion on the ballot. Montana’s results are not yet final, but the measure passed in the other three states.

Montana had temporarily expanded Medicaid about two years ago; the vote was to decide whether or not to make expansion permanent.

Fifty-three percent of Nebraskans who voted checked the “expansion” box, despite strident requests from Republican Gov Pete Ricketts to vote no. Utah passed the referendum by about the same margin, while Idahoans were even more supportive, with 62% voting in favor.

Departing Maine Gov. Paul LePage refused to expand Medicaid even after more than 60% of voters demanded just that in a referendum last year. Gov.-elect Janet Mills has promised to begin expansion on day one of her term in office.

Montana might be a different story. Early returns indicate a $20 million anti-Medicaid campaign backed by the tobacco industry may have been effective. The measure would have increased the price on a host of tobacco products by $2 to cover the state’s costs.

Notably, hospital groups in each state were strong supporters of each initiative, as they have been in pretty much every state since the Affordable Care Act was passed. I’d expect to see more states expanding Medicaid in the future in a replay of the original Medicaid rollout from the mid-1960s.

With the rollout, rural hospitals and those with higher proportions of poorer patients are getting a financial lifeline, one that they sorely need.

What does this mean for you?

Medicaid expansion is inevitable, and that is good news for hospitals, and it decreases pressure to cost-shift to other payers.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.