There are countless ways in which this summer has been remarkable, including how the COVID-19 pandemic continues to dominate our daily lives and continuing the movement to highlight systemic racism. As patient advocates, we can add another “remarkable” to the list: within a five-week period this summer in two states where elected officials had been resistant, voters took matters into their own hands and decided to increase access to health insurance coverage for low-income residents by fully expanding their Medicaid programs at the ballot box.
When the initiatives go into effect, an estimated 200,000 low-income parents and adults in Oklahoma and 230,000 in Missouri, will gain access to health insurance. To say these are anything less than incredible wins for our mission would be an understatement. Just as outstanding as both Oklahoma and Missouri expanding access to care through Medicaid in back-to-back elections is how this was accomplished: These mark the fifth and sixth states since 2017 to pass Medicaid expansion via ballot measure, following in the footsteps of Maine, Idaho, Nebraska and Utah. Notably, policymakers in each of these states had historically been reluctant to expand access to care through Medicaid.
By no means is a ballot measure always the most desirable method to change public policy. Ballot initiatives tend to be costly, and passage of an initiative does not equate instant implementation. Effective implementation can take years of advocacy to defend against efforts to enact barriers that water down the measure. However, they can serve as a successful strategy if opportunity for advancement through the state legislature has been exhausted, as was with both of these cases this summer. ACS CAN has strategically engaged in ballot measure campaigns in both our Medicaid work and in our important tobacco control efforts at the state and local levels when other more traditional policy change approaches have proven less successful.
There’s no doubt in my mind that timing was a pivotal factor in these successes. The COVID-19 pandemic has placed immense pressure on our country’s health care system; millions of people across the nation have become uninsured after losing their jobs during the pandemic, and those in non-expansion states are especially vulnerable without other safety net coverage options. If nothing else, a potentially valuable long-term consequence of the pandemic is that it’s brought the need for access to health insurance coverage more urgently to the forefront of the minds of policymakers and voters alike.
That said – timing isn’t everything. The commitment of health advocates was equally essential to getting these campaigns over the finish line. I’m incredibly proud of the many ACS CAN volunteers and staff in both states for the years of voter education and community engagement that laid the groundwork for these ballot measures and the media advocacy that helped amplify the campaigns. It’s that deliberate work that created the “fertile ground” that allowed for these wins. We are also proud of the strong coalition work with other public health partners that led to these victories, which will be of significant benefit to these states’ economies and hospitals.
I’m optimistic that the momentum this summer will only continue to grow. There is concrete evidence that expanding Medicaid is advantageous to our cancer mission, by increasing access to preventive care including timely cancer screenings. Increasing access to care is also a core tenet of any policy intervention to reduce longstanding inequities in health outcomes. ACS CAN calls on legislators in the remaining 12 states that have not yet expanded to increase access to health insurance coverage through Medicaid for all cancer patients, survivors and those at risk of the disease. This year will be historic for myriad reasons. I’m proud to add “reducing the cancer burden” to the list.
The true costs of cancer are heavy, they are deep, and they are ultimately unaffordable for many, a challenge further exacerbated by this year’s COVID-19 pandemic and spotlighted by the upcoming Supreme Court case challenging the Affordable Care Act.