Did Gerrymandering Kill Medicaid Expansion?

Partisan gerrymandering of legislative districts has been blamed for many things — polarization, voter suppression and more.

A new report issued Monday by the liberal group Center for American Progress links it to another issue: stalled legislation that would expand health care coverage, primarily accepting federally subsidized Medicaid expansion offered under the Affordable Care Act (ACA). The issue affects Wisconsin and several other states, including Michigan and North Carolina, CAP says.

“By gerrymandering their districts, politicians can stay in power — and keep their political parties in power — even if they lose voter support,” the CAP report asserts. “And that means that on issues such as the expansion of Medicaid, conservative politicians can cater to the extreme right wing and oppose policies that would save lives at minimal cost to state taxpayers.”

By expanding Medicaid eligibility to include people with incomes up to 138% of the federal poverty level, along with a guarantee that the federal government would bear at least 90% of the cost of the additional coverage, the ACA enabled about 13 million people to get health coverage who would not have gotten it otherwise, the report notes.

Republican control of state legislatures — and therefore redistricting in most states, where lawmakers are in charge of drawing legislative maps — gave them “more ability to gerrymander than Democrats,” the report says, so that they “were able to skew state election outcomes — and therefore state policy — in a more conservative direction.”

The shifts have affected not only states where legislatures shifted from Democratic to Republican control but also consistently Republican-led states where gerrymandering led to a shift from moderates “who may be more inclined to compromise” to lawmakers “on the ideological extremes,” according to the report.

Drawing on data compiled by the Urban Institute, the CAP report concludes that in three states, Georgia, North Carolina and Wisconsin, nearly 1 million people went uncovered by health insurance, and as many as 3,000 people died from preventable medical causes.

In the 2018 Wisconsin elections, “Democratic candidates received 54.2% of the votes for the State Assembly — a clear majority,” the report notes. “They also received 49% of the votes for the state Senate — a near majority, but not quite enough to control the upper chamber even with fair maps.”

Because of the way Republicans drew voting districts for the state Legislature in 2011, however, “Republicans won sizable majorities of the seats in both chambers — 63.6% of the seats in the State Assembly and 60.6% of the seats in the Senate,” the report states — and have blocked Gov. Tony Evers’ efforts to accept the federal Medicaid expansion.

Jay Heck, executive director of Common Cause Wisconsin, said that before Evers’ election in 2018, Wisconsin’s failure to accept federal Medicaid expansion has another dimension as well: former Gov. Scott Walker’s presidential ambitions in the years leading up to 2016.

“Walker was not going to accept Medicaid expansion for that reason,” Heck said. “He wanted to be a conservative purist.”

The CAP report notes Walker’s role in the state’s rejection of Medicaid expansion, and observes that a partial expansion the Walker administration implemented in 2013 instead of accepting the federally backed approach “ended up costing taxpayers at least $1 billion more” than accepting the full ACA Medicaid expansion.

The CAP report also links gerrymandering with the imposition of work requirements on Medicaid recipients, a policy that a federal judge has ruled against because it “failed to consider what impact those requirements would have on the central purpose of Medicaid: providing health insurance to those who cannot afford it.”

In Michigan, the report said, while the Democratic governor has accepted the Medicaid expansion the ACA offers, the Republican-controlled Legislature imposed work requirements and more demanding reporting.

Reprinted with permission of Wisconsin Examiner.