Neither does Kansas, where the Republican-controlled Legislature voted to expand Medicaid earlier this year but failed to override a veto by Gov. Sam Brownback. Mr. Brownback is awaiting confirmation to an ambassador at large position in the Trump administration, but Lt. Gov. Jeff Colyer, a fellow Republican who would replace him, has also indicated he would resist expansion.
Still, David Jordan, who leads the Alliance for a Healthy Kansas, an advocacy group, pointed out that if Mr. Colyer becomes governor, he will face re-election a year from now in a state where polls have found resounding support for expanding Medicaid.
“Yesterday’s results in Virginia and Maine should send a message to him,” Mr. Jordan said. “It could become really tough to go against this wave.”
But for many Republican politicians, the idea of expanding Medicaid remains hard to love. Providing government insurance coverage to poor adults who are not disabled is anathema to many. They view such help as discouraging work, though data suggests most new Medicaid recipients have jobs and states that expanded did not see reductions in employment among low-income people.
Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, which oversees the program, told state Medicaid directors on Tuesday that her department would begin approving state plans to condition Medicaid coverage for non-disabled adults on work or volunteer hours.
“Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” Ms. Verma said. “Those days are over.”
Several states have asked Ms. Verma’s office for permission to impose work requirements on Medicaid beneficiaries. Matt Salo, the executive director of the National Association of Medicaid Directors, said that he thought work requirements might make expansion more acceptable to some state legislatures, like Florida’s, that have been reluctant in the past. “You can rebrand that,” he said. “You can do that very effectively.”
The federal government paid the entire cost of expanding Medicaid for the first three years of Obamacare, but that changed this year. States now must pay 5 percent of the new beneficiaries’ medical bills, a proportion that will increase to 10 percent by 2020. So any state that expands now will need to find some funding to pay for its share.
States that expanded Medicaid expect to spend $8.5 billion from their own funds on expansion in the 2018 fiscal year, according to the National Association of State Budget Officers.
“Every political decision is about value, and the value is what’s the return for the money,” said Tony Keck, a former director of South Carolina’s Department of Health and Human Services, a state that has not expanded. Mr. Keck, now a hospital executive, said that legislators there thought it was more important to invest in existing populations of Medicaid beneficiaries than to expand the program to cover childless adults.
In Utah, a newly formed political committee called Utah Decides Healthcare just concluded seven required public hearings around the state and hopes to soon start gathering the 113,143 signatures needed to get an expansion question on next year’s ballot. The Republican-controlled legislature could interfere if the initiative were to pass, but RyLee Curtis, the campaign manager for the Utah effort, said she doubted it would because Gov. Gary Herbert and the State Senate had tried to expand Medicaid in the past.
Jonathan Schleifer, the executive director of the Fairness Project, a left-leaning group founded in California that donated nearly $700,000 to the pro-expansion campaign in Maine, said the group was eager to help the efforts in Utah and Idaho and scout out other states where ballot initiatives might work.
“Grassroots groups in other states were waiting to see what happened last night and now they know what’s possible,” said Mr. Schleifer, his voice hoarse from whooping at a victory party in Maine on Tuesday night. “In the next couple weeks we’ll be able to start talking about what other states have the ability to run these initiatives and the grassroots enthusiasm to do that.”