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Slow Way Back to Health Care Status Quo

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The big ballot measure in Tuesday’s elections is in Maine, where voters will decide whether, as Jeffrey Young reports, to become the 32nd state (plus the District of Columbia) to adopt expanded Medicaid under the Affordable Care Act.

Yes, this is big news. The history so far of Medicaid expansion is that it’s a one-way street: States that go for it don’t exit, even when anti-Obamacare Republicans are elected vowing to do exactly that. As Sarah Kliff observes, if this is successful, expect similar measures in those states that have voter-initiated ballot measures but haven’t expanded Medicaid so far. At the same time, Democrats will probably pick off a few governor seats and state legislature chambers in the 2018 midterms, perhaps allowing them to accept the Medicaid expansion in a handful of states.

(Related: Bernstein on Politics: 2020 Election Shapes Up to Be a Wild Ride)

Certainly that’s good news for Affordable Care Act supporters, especially coming out of the defeat of the Republican repeal effort in Congress this year.

At the same time, Kimberly Leonard reports that the Donald Trump administration may be planning an executive order to undermine the Obamacare individual mandate. There’s also talk that the House may add a repeal of that mandate to their tax bill — it would save the government money because fewer people would buy insurance through the marketplaces.

The problem, however, is that repealing the mandate may well be a deal breaker for Republican senators such as Lisa Murkowski and Susan Collins. Since Republicans can only afford to lose two senators on the tax bill, and others have said they’ll oppose it because of its increases in the deficit, it’s likely that at best this would be a gimmick to get the bill through the House, dump it on the Senate, and let them either figure it out or take the blame. And, yes, I for one am surprised that it appears the House may be shifting into blame-ducking mode on the tax bill, just as they did on the health bill.

Back to the individual mandate: It’s certainly possible that the Trump administration could go through with an executive order to eliminate it.

It still makes no sense, however. Blowing up the individual market in health insurance in order to blame it on the previous administration just seems like very foolish politics, since most swing voters will blame the incumbent party for things that go wrong, correctly or not. Whether the logic of the situation will constrain the president and his administration is, as usual, unknown.

I still do think we’re eventually on the way to health care politics as usual, in which the parties differ on spending and policy around the edges but acc

— For more columns from Bloomberg View, visit


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