While there was a slowdown in action on health care in Washington due to the shutdown there were some debates taking place in some states as far as the Affordable Care Act.

In Idaho opponents to expanding Medicaid coverage under the ACA went to the state Supreme Court to overturn a 2018 voter initiative that directs the state to expand the ACA through Medicaid. The Medicaid option initiative received 61 percent of voter approval last November.

The Idaho Freedom Foundation told state justices that the initiative that passed in November with more than 60% of the vote is unconstitutional because it gives authority to the federal government and the state Department of Health and Welfare. Opponents of the Medicaid expansion told justices if Idaho expanded coverage with the federal government covering 90 percent of the cost, the state could get stuck if the federal; government later cuts coverage. The justices seemed to question that logic—that has been used to delay Medicaid expansion in other states. Justices suggested there would be nothing stopping the state from later rejecting the Medicaid expansion.

At the same time in the state of Utah, where voters also approved the Medicaid option, members of the state legislature are examining ways they might restrict access including through work requirements and coverage that is more limited than 138 percent of poverty income level set in the ACA.

Utah and Idaho are one of three states along with Nebraska to expand the Affordable Care Act optional Medicaid coverage as result of last November’s election. A fourth state, Maine, had already voted in 2017 with 59% approval to expand the ACA through the Medicaid option but that expansion had been blocked by the previous Republican governor. With a new governor, Democratic Janet Mills, that expansion has been implemented.

One state that is looking at ways to strengthen the ACA is California. New Governor Gavin Newsom (D-CA) is proposing a state individual mandate to purchase insurance. This state mandate would replace the Trump Administration and last year’s Republican Congress actions which repealed the tax that was the enforcement tool for the individual mandate to buy health insurance.

In Washington DC, advocates are concerned about some reports that the Trump Administration is encouraging states to apply for a Medicaid block grant. The Administration would attempt to grant such a block grant through waiver authority. This would happen even though such proposals, with the opposition of many groups including CWLA, was never able to pass the last Congress.