“I’ve never been sober a day or two since I was 16,” Omps, who was 34, texted her sister on Oct. 5 of last year. “I do not want to be addicted. I fucking hate needing something to feel normal. I might as well actually get high if I’m going to be an addict.”

Though she resented the suboxone, people close to her said it was crucial to her recovery from substance use disorder. And so it was catastrophic that she could no longer obtain it, midway through 2023, after she was kicked off Medicaid. 

At the onset of COVID-19, the federal government suspended normal rules for Medicaid to keep people from losing coverage during the pandemic, allowing recipients, including Omps, to go three years without having to demonstrate eligibility. But that policy ended in March 2023, and Omps and millions of others across the country were swiftly dropped from government coverage—for instance because they forgot to file for renewal or made a mistake on their paperwork, or because they had moved to a new state or started earning too much money to qualify for Medicaid. In West Virginia, this change was compounded by the existing staffing and funding challenges in the state’s Medicaid office, and the legislature’s inaction to avert this cliff.

In 2022, Omps started working at the nonprofit West Virginia Family of Convicted People, where she organized events to protest and raise awareness about conditions inside West Virginia’s deadly jails. The job paid $22 an hour, which put her in a difficult spot: She was making too much money to stay on Medicaid, but the job didn’t provide health insurance and Omps didn’t couldn’t afford to pay out-of-pocket for her drug treatment.

“She had to go off of suboxone and that is what put her body under a lot of stress,” Omps’ sister, Victoria Omps, told Bolts recently. “It was so hard on her, because of how expensive it was going to be to stay on.”

Already in withdrawal from hard drugs, Omps suddenly found herself in withdrawal from the medication that was treating her addiction. On Oct. 18, she entered the steam room of a YMCA in Charleston, West Virginia’s capital city, then collapsed and died as she got up to leave. She was 34 years old, and though she officially died of a heart attack, Victoria and others who knew Ashley told Bolts they have no doubt about what killed her.

“I think it was entirely about her having to come off of suboxone,” Victoria said. “The withdrawal was so hard. That was the reason she was even in the steam room, so she could try to sweat it out of her pores.”

The so-called unwinding of Medicaid coverage has, as of late last month, led to the disenrollment of more than 17 million Americans, according to a Kaiser Family Foundation analysis. West Virginia has been hit particularly hard: It is one of the poorest states in the country, and thus has one of the highest rates of Medicaid enrollment. The return to normal Medicaid rules has led to the removal of nearly a quarter of all West Virginians who’d been enrolled as of last spring, the Kaiser analysis shows.

Those who work in drug treatment and addiction recovery in West Virginia say this drop-off in coverage has endangered people with substance use disorder and compounded a larger crisis in a state that has already led the country in overdose death rate every recorded year since at least 2014, according to federal data. 

As patients like Omps lost access to addiction treatment, advocates pressed state leaders to expand Medicaid eligibility and treatment options in the state. Instead, even in the face of this crisis for drug treatment and recovery, many West Virginia lawmakers have turned to a different approach, pursuing new punishments for people addicted to illegal drugs in a state that already incarcerates more people for drug possession than for almost any other charge. 

The state legislature, which is controlled by Republican supermajorities, already restricted syringe exchange programs in 2021; this year, it considered bills to outlaw syringe exchanges entirely, as well as to ban methadone—a medication that treats opioid addiction, as suboxone does—and the distribution of clean drug supplies. West Virginia lawmakers also have repeatedly advanced legislation to turn simple drug possession from a misdemeanor to a felony offense punishable by up to five years in prison. 

“We’re trying to be proactive here,” Republican state Senator Vince Deeds, the sponsor of that proposal, told Mountain State Spotlight in January. “Right now, if you have someone go in for simple possession, they’re back out and they’re committing more crimes to feed their habits. The idea here is to have early intervention with these end-level users.” (Deeds did not respond to multiple requests for comment from Bolts.)

Deeds’ bill passed the state Senate both in 2023 and this January, but it stalled in a House committee last week as lawmakers declined to pass it. Instead, House Republicans decided to study higher penalties for drug possession in the future, which would push this focus on increased penalties into coming years. 

Many who advocate for those struggling with addiction in West Virginia feel frustrated seeing lawmakers focus during their limited time—the 2024 session is already set to end this week—on such solutions. These advocates argue that treatment offers more public safety benefits than harsher punishment, a position bolstered by years of research showing that incarceration does not deter drug use. 

“Instead of putting the money and funds into increasing access to treatment, increasing resources and funding to organizations helping with drug treatment, they’re talking about throwing good money after bad by increasing penalties and increasing incarceration rates,” said Kenneth Matthews, a recovery coach who is himself in long-term recovery from addiction. 

“There’s not enough money put into treatment facilities,” he said. “Never in the history of people committing crimes has anybody in the midst of their substance use said, ‘Oh, they just increased the penalty, so I’m not going to do this.’ As someone who was formerly incarcerated and in long-term recovery, when I was in the midst of substance use I wasn’t following the legislature and I really didn’t care.”

David Foley, the chief public defender in Mingo County, a rural area in the southern part of West Virginia that The Guardian once called “the opioid capital of America,” said he sees a host of other criminal charges that seem to stem from untreated addiction. “I see so many crimes where, if they are not drug offenses, they are fueled by the desire to get money to get drugs, or it’s people so down on their luck because of drugs,” Foley said. “It just seems like the entire spectrum of criminal charges are in some way influenced by substance abuse.”

Mingo County Sheriff Joe Smith, a Republican, confessed that he sometimes wonders whether arrests and incarceration for certain drug charges are doing any good for people suffering addiction. Smith told Bolts that he and his deputies often arrest the same people over and over again for the same drug-related crimes, and added that even if he could arrest every single person who sells drugs in the area, he doesn’t think Mingo County could solve its problems related to addiction through enforcement alone.

“Out of every crime we work, 80 percent is drug-related. We’ll arrest someone who stole grandma’s earrings, but when you get to the root of it, it was to sell the earrings for a hit of meth or some fentanyl,” Smith said. “It’s a sad situation. I’ve arrested people, and arrested their kids, and worked overdoses off people who I’ve begged to get help.”

Overdose deaths are a regular occurance in Mingo County, which has a population of just over 20,000. Rebecca Hooker, who runs a social services organization in the county, told Bolts that, recently, on a single day in a single 10-mile radius, her community saw four people die of suspected overdoses. “The people in the sector of harm reduction or prevention or rehabilitation really need more money,” Hooker said. “Right now it’s just catch and release.”

Matthews said his work as a recovery coach is particularly difficult these days, now that he must contend with the fact that many of his clients, who are already at high risk of incarceration or overdose—or both—are also trying to navigate the ongoing Medicaid mess. He talked about one client who had to leave a treatment facility because they lost Medicaid coverage, then spent months re-establishing eligibility, only to find that the treatment facility had no bed space for him to return.

“I was worried he’d have a fatal overdose,” Matthews said. “People lost their health care and had to leave their residential programs because they no longer had the ability to pay for it through Medicaid. Some of them were able to hold on and some were not.” 

West Virginia’s state Medicaid office has faced criticism for not doing enough to help people keep coverage after the rules changed. In a letter last summer, the federal Centers for Medicare and Medicaid Services admonished the state for keeping people on hold for long periods of time when they called in for help, and warned that this and other forms of administrative dysfunction would lead to many eligible people losing coverage. 

Rhonda Rogombe, health and safety net analyst for the West Virginia Center on Budget and Policy, said administrative hurdles have been a particular problem for people needing treatment for substance use disorder. “This is a very vulnerable group of people,” she told Bolts, “and they’re being disconnected from programs they were enrolled in, or could be eligible for.”

Deborah Ujevich, who works at a detox facility outside Charleston, and was close with Ashley Omps, says people have been scrambling over the past year to find addiction treatment after losing Medicaid coverage. “People would call us for a bed and you look their Medicaid up with the system, you go look at member eligibility, and you see no enrollment found,” Ujevich said. “So you can’t take them, and they can’t get meds because the pharmacy isn’t going to fill their protocol.”

Omps’ death while searching for treatment was sadly not unique, Ujevich said, adding, “We have had a number of past patients die because they aren’t getting the care that they need.”

She finds it frustrating that the state continues to pursue harsh enforcement despite little evidence that incarceration is helping to stem substance abuse, especially after so many lost access to addiction treatment under Medicaid.

“They are doubling down here on bad policy and they are not taking into consideration what is actually happening. It’s very, very, very out of touch,” Ujevich said. “We’re really going backward.”

The post Drug Treatment Crisis Grows in West Virginia, But State Just Looks Toward More Punishment appeared first on Bolts.

Lawmakers in Oregon, a state that already leads the nation in electoral engagement, adopted legislation this summer that would make voting even more inclusive. If it is signed into law by the state’s Democratic governor, House Bill 2107 would instruct state Medicaid offices to automatically register people to vote when they open or renew a health plan. 

The bill could add tens of thousands of people to voter rolls by allowing the Oregon Health Authority to forward basic information it collects from people applying for Medicaid coverage—age, residence, and citizenship status—to election officials. These officials would then use it to register anyone who is eligible to vote and but not already signed up to do so.

This process, which would still give people the chance to decline being registered, is nearly identical to Oregon’s existing system of automatically registering people. But that system only applies at the Driver and Motor Vehicle Services department, leaving out Oregonians who don’t visit the DMV. 

“Voter registration shouldn’t be dependent on going to the DMV, because not everybody does,” said Isabela Villarreal, policy director for Next Up Action Fund, a group that helped bring automatic voter registration to Oregon in 2015, explaining that lower-income and younger Oregonians are less likely to use DMV services. “We just want to make sure we’re capturing every single person and allowing them to participate.”

According to the secretary of state’s office, 85 percent of all Oregonians who are not registered are enrolled in Medicaid, a program that serves people living near or below the federal poverty line. That’s roughly 170,000 people in this state of 4.2 million who could be added to the voter rolls if the state began automatically registering Medicaid recipients. 

“This is a critical opportunity to register people that have been historically and currently excluded from our electoral systems,” Villarreal said.

The reform, however, comes with a catch: It would not actually change anything unless Oregon wins the blessing of the federal government, which for years has held up similar proposals in other states and told Bolts it’s still reviewing the issue. Medicaid is a program administered by states but regulated by the federal government, which largely bars a state’s Medicaid office from disclosing information to other agencies without the U.S. Department of Health and Human Services’ authorization.

Colorado, for one, adopted a reform similar to Oregon’s in 2019, only to see the federal agency that administers Medicaid stall its application over privacy concerns. Colorado’s secretary of state, Democrat Jena Griswold, shared her frustration with Bolts last week, saying she struggles to even get answers from federal officials. “It would be great for Colorado to implement it,” she said. “We should be working to streamline people’s interactions with the government.”

Advocates for expanding voter registration hope that the growing number of states seeking to automatically register Medicaid recipients will motivate the Biden administration to revisit its stance and greenlight new  reforms in Colorado, Oregon, and elsewhere.

Oregon eight years ago became the first state to adopt automatic voter registration, or AVR, and today similar systems exist in almost half of U.S. states. The design differs greatly by state, but the core idea is simple: Instead of expecting people to take proactive steps to register, a government agency uses the information they already collect to register people, while still giving them an opportunity to opt out. 

AVR has been proven to boost registration and turnout, and make the electorate more diverse. In Oregon, roughly 94 percent of eligible residents are now registered to vote. 

But in Oregon, as in many states, AVR is limited to people who visit the DMV, an agency with which many people, especially low-income residents, just don’t interact. Oregon voting rights advocates say this helps explain why nearly 200,000 eligible voters in the state—roughly 6 percent of the voting-eligible population—remain unregistered. They’re hoping that reaching Medicaid recipients gets the state closer to universal registration.

Sylvia Albert, director of voting and elections at Common Cause, a national voter advocacy organization, says including Medicaid recipients would make AVR systems far more inclusive. 

“These are the people who generally fall through the cracks in our voter registration system: people who might be more transient, people who are less affluent, people who are unable to take time off work to go vote, older individuals who don’t have their documentation in order,” she told Bolts. “These are the type of people that, in general, face more barriers to the ballot. If we can reach those people with something like this, I don’t see a reason why we wouldn’t.”

Oregon Governor Tina Kotek, who has until late July to take action on HB 2107, did not respond to questions for this story. Local observers told Bolts they expect she will sign the legislation.

Several other states, including Colorado, Massachusetts, Nevada and New Mexico, have already had the same idea and passed legislation to extend AVR systems to government health programs. “The DMV seemed like the big first place to get the most people registered,” Griswold, the secretary of state of Colorado, told Bolts. “We believe Medicaid is that second place.”

But the Centers for Medicare and Medicaid Services (CMS), the federal agency housed within HHS that oversees the Medicaid program, has left most of those states in limbo for years. Oregon may be next, as state officials there say HB 2107 cannot be implemented without CMS authorization. 

CMS rules bar state Medicaid agencies from using or disclosing client data for purposes that are not directly connected to the Medicaid program, but a state can request a waiver to implement a specific proposal, or ask CMS to determine that the way in which it plans to use the data is indeed legitimately connected to health care administration. Medicaid law experts say the prohibition exists to protect people from having their information used against them—police can’t turn to Medicaid for a person’s last known address, for instance, nor can prosecutors in states that punish abortion patients.

Colorado’s attempt to implement AVR through Medicaid has gone nowhere since 2019, first under the Trump administration through early 2021, and then under the Biden administration. When Colorado U.S. Senator Michael Bennet wrote a letter to CMS last year imploring the agency to green-light Colorado’s reform, CMS Administrator Chiquita Brooks-LaSure wrote back that the agency “had previously concluded that [the state’s proposal] appears to be inconsistent with the Medicaid privacy protections in current laws and regulations.” 

But Brooks-LaSure, who was nominated to the position by President Biden, also referred to an executive order Biden issued soon after his inauguration directing all agency heads to “evaluate ways in which the agency can, as appropriate and consistent with applicable law, promote voter registration and voter participation.” Brooks-LaSure added that CMS is “exploring opportunities to enhance Medicaid’s role in promoting voter registration.”

CMS told Bolts in a statement on Monday that “this issue is under review.”

CMS did not say whether it had reached any new conclusion since Brooks-LaSure’s letter to Bennet more than a year ago. When Bolts first reached out to CMS seeking clarity, the agency said in a statement that AVR systems “may” breach Medicaid’s confidentiality rules but a CMS spokesperson reached out days later to say the agency’s initial response had been rushed and “provided in error,” and reflected the view of the Trump administration. The agency then issued another statement that kept the door open to new state initiatives.

“In keeping with the President Biden’s Executive Order directing federal agencies to promote access to voting, we recognize the importance of state Medicaid agencies assisting in expanding voter access and registration activities for the populations they serve,” CMS said. 

CMS did not reply to follow-ups requesting more information about its review process.

The picture gets fuzzier considering Medicaid services are already automatically registering people in Massachusetts. States Newsroom reported last week that the state had seen a large jump in registration as a result. 

Michelle Tassinari, an attorney in the Massachusetts Secretary of State’s office, told Bolts she is confident that the state is compliant with federal rules because Massachusetts asks people, during their initial interactions with the health agency, if they’d prefer that their information not be used for the purpose of voter registration. Washington state also registers people through its health agency using a similar approach, a process known as “front-end” AVR. 

Automatic voter registration looks different in Oregon, as well as in Colorado. Instead of being asked if they want to opt out of registering during their transaction with an agency, prospective voters receive a mailer later on; they must respond to it if they do not wish to be registered. Data show that this approach, known as a “back-end” system, registers many more people to vote than when people are asked up-front, and more states have been switching to this model.

CMS did not answer Bolts’ questions when asked if these design distinctions were relevant to how the federal government is assessing state-level AVR programs. 

This confusion reflects what officials in the states that are in limbo have experienced. 

Griswold told Bolts that she’d be happy to hear the federal agency’s specific concerns and reach a workable solution, including by adjusting the exact design of Colorado’s system, but that CMS hasn’t even created the opportunity or shared precise feedback.

“We do not see a big difference between AVR at the DMV versus at Medicaid offices,” Griswold said. “If CMS thinks there’s a big difference, we can always address that in the law, we can go back and tighten the law if they want. But they need to give us guidance.”

Griswold doesn’t dispute the importance of protecting privacy but she believes this isn’t that complicated or fraught. “I think you can design the system where states never interact with the underlying data,” she said. “We do not need to know anything about people’s medical information, nor do we want to know that information.”

Other election experts also point out that the design of existing AVR systems already integrates privacy protections. The goal, they say, is to make use of data the government already collects without weaponizing it.

“If it’s administered correctly, I don’t see it being any different than [automatic voter registration] through the DMV,” Lacey Donaldson, the elected clerk in Pershing County, Nevada, and the head of that state’s county clerk association, told Bolts. Nevada’s plans for automatic registration of Medicaid recipients is also in limbo due to CMS.

One difference between the DMV and health services is that Medicaid recipients interact with the state more frequently. In Oregon, Medicaid recipients must renew their plans and update their information—including their mailing address—annually, whereas many people go years without visiting the DMV. This means that administering an AVR system through Medicaid would be likelier to keep voter rolls up-to-date.

“This is a win-win-win-win for lots of different people,” says Amber McReynolds, a national expert in election procedures who was appointed to the U.S. Postal Service Board of Governors by Biden. “The people who want to make sure more people are registered to vote, for people who care about making sure voters addresses are accurate, for people who want more efficient government. It’s one of these concepts I always think that everybody should like.”

In Oregon, the concept was championed by Shemia Fagan while she was secretary of state. Fagan, a Democrat, resigned in May after Willamette Week revealed she’d been accepting lucrative consultant payments from cannabis entrepreneurs who have been top donors to her political career. Still, the legislation passed based on strong support from Democratic lawmakers who run both chambers; Republicans opposed the legislation. 

Other states may soon join the CMS waiting chamber. A new bill introduced last month in New Jersey proposes expanding that state’s AVR system to include Medicaid services.

“We’re hopeful that CMS will reconsider its reading of the law, which we think is currently incorrect,” Griswold said. “State pressure is mounting.”

The post Oregon Wants to Register Medicaid Recipients to Vote. Will Biden Officials Allow It? appeared first on Bolts.

The result is a stinging defeat for the latest conservative effort to shut down popular initiatives, which in recent years have been a rare tool for progressive policies in red states. And it salvages a path for tens of thousands of people to newly qualify for public health insurance this fall.

Republicans rushed to place Amendment C on the June ballot to thwart a voter-initiated referendum on expanding Medicaid, scheduled for November. If Amendment C had passed on Tuesday, it would have changed the rules of that upcoming referendum—raising the threshold for passage to a tricky 60 percent.

Instead, the Medicaid expansion now only needs to clear 50 percent in November. Even in a ruby red state, that is an achievable goal. Since 2017, Medicaid expansion initiatives have met that threshold in all six states that have voted on it—Idaho, Maine, Missouri, Nebraska, Oklahoma, and Utah. 

Amendment C would have required a supermajority for any ballot initiative that is set to require $10 million of expenditures over five years. It was championed by conservative groups like the Koch brothers’ Americans for Prosperity. The organization framed the amendment as an anti-tax measure, arguing it would make tax hikes harder. But the Koch network has aggressively fought Medicaid expansion efforts in many places.

In red states, once Medicaid has hit the ballot, groups not typically associated with progressive politics have fueled its momentum. During Idaho’s referendum, the state’s sheriff association endorsed the initiative, casting it as a form of criminal justice reform. “Expanding coverage to low-income people with health issues or mental health issues,” a local sheriff said on behalf of the association, can “keep people out of jail” and make them “less likely to end up back in the system.” 

People released from incarceration often struggle to secure health insurance—an even greater hurdle  in states that restrict Medicaid eligibility. People in those states also have fewer options if they want to access treatment for issues that are widely criminalized like mental illness or substance use. These ramifications have helped fuel campaigns to expand Medicaid, most recently in Missouri, a state ravaged by the opioid crisis. While Americans for Prosperity does support some criminal justice reforms in red states, they also fight efforts to strengthen public services and health programs that could shrink incarceration (the group’s  South Dakota chapter did not respond to a request for comment).

South Dakota’s dominant Republican Party has blocked the Medicaid expansion ever since the U.S. Supreme Court made it optional for states in 2012. But the state’s GOP leadership has not been entirely united on the issue. Former Governor Denis Daugaard proposed broadening Medicaid during his tenure, only to be shrugged off by the legislature; meanwhile the proposal to put Amendment C on the June ballot barely passed the state Senate, with many Republican lawmakers voting against it.

The state’s current governor, Republican Kristi Noem, is a steadfast opponent of expanding Medicaid, raising questions about how, or even whether, state officials would actually implement it if voters instructed them to do so in November. In some though not all states that have voted on the issue, GOP politicians dragged their feet on expanding health care access if not outright ignored voters’ mandate.

Noem has already shown that she is ready to fight the will of her electorate. After voters legalized marijuana in 2020, she asked state courts to strike down the initiative on procedural grounds. The state supreme court, which is entirely made of GOP appointees, agreed last year. 

South Dakota Republicans have taken other steps to erode direct democracy, including a law last year that made it much more burdensome to gather signatures for an initiative, part  of a nationwide push by conservatives to limit voter-initiated proposals. Making ballot initiatives more onerous could have grave consequences for progressives, who have managed to successfully organize in red states to circumvent conservative legislatures on behalf of expanding Medicaid, increasing the minimum wage, hiking taxes on the wealthy, and strengthening voting rights.

GOP lawmakers in South Dakota were not able to increase the threshold of passage for initiatives on their own, without consulting voters, since the change would have affected the state constitution. And South Dakotans’ refusal to go along with this stands out as reaffirming the state’s historical legacy.

South Dakota was the first in the nation to adopt a process for citizens to initiate ballot measures. In 1898, voters approved a constitutional amendment to that effect that was pushed by local populist leaders—a legacy that voters reaffirmed on Tuesday. Among the 1898 measure’s chief champions was Robert Haire, a Catholic priest who clamored for democracy to be more direct. 

“These men make the laws to suit themselves—are a law to themselves,” Haines wrote about political leaders in the Dakota Reporter in 1891. “Of course, the entire plutocracy, given over to fleecing the values that labor produces, are afraid of the people.”

Quinn Yeargain contributed to the reporting for this article. Read their article that previewed Tuesday’s election.

The post South Dakotans Refuse to Weaken Ballot Initiatives, Keeping Hopes Alive for Medicaid Expansion appeared first on Bolts.

Healthcare advocates pursued a ballot initiative to get around their Republican-run legislature, which has refused to expand Medicaid under the Affordable Care Act for the past decade. But state Republicans have responded by rushing to change the election’s rules.

The legislature placed a constitutional amendment on the state’s June 7 primary ballot that would make it far harder for future ballot initiatives to succeed, starting with the Medicaid measure that is scheduled on Nov. 8. 

Amendment C, if adopted next week by the smaller pool of voters who decide primaries, would set a higher threshold for future ballot measures that involve spending more than $10 million over a period of five years—something that expanding Medicaid would inevitably do. Such ballot measures would need to gain the approval of 60 percent of voters, up from 50 percent. 

The GOP’s bid to thwart the Medicaid initiative in South Dakota adds to a series of moves by the party to weaken direct democracy. In many states that Republicans dominate, progressive organizers have successfully appealed to voters with measures like Medicaid expansion that conservative legislatures have blocked, triggering intense backlash by Republican politicians against procedures of direct democracy that they are failing to control. In Idaho and Utah, the GOP’s new restrictions on ballot initiatives also closely followed Medicaid referendums.

The erosion of direct democracy resonates deeply in South Dakota, which was the first state in the nation to set-up a popular initiative process. Inspired by populist demands for new checks on politicians, the state’s 1898 reform empowered ordinary citizens to initiate ballot initiatives.

Just over the past decade, South Dakotans have approved initiatives to raise the minimum wage, create an independent ethics commission, and legalize cannabis.

Republican politicians have responded by gradually restricting the initiative process. In 2016, voters adopted the South Dakota Accountability and Anti-Corruption Act, which set new ethics rules and created a system for public financing of political campaigns. Republican politicians repealed the measure, arguing that voters didn’t understand what was in it when they passed it.

The legislature then crafted two measures to make it harder for voters to initiate initiatives. The first would have required all constitutional amendments to receive 55 percent of the vote to be ratified, but South Dakotans rejected the proposal in 2018. They passed the second, which requires constitutional amendments to only relate to a “single subject.” Most states with ballot initiatives have such requirements, but there is tremendous variation in how this language gets interpreted. Some state supreme courts apply it broadly and only rarely hold that a proposal violates it, while others apply it much more stringently, routinely striking down proposals.

South Dakotans quickly learned that their supreme court, made up entirely of GOP appointees, would interpret the new requirement strictly. After voters approved legalizing marijuana in 2020, Republican Governor Kristi Noem challenged the constitutionality of the measure, and the state’s high court struck it down for encompassing more than one subject in November.

State Republicans further escalated their war on popular initiatives last year with a law that increases the font size of ballot petitions while requiring that the entire text fit on one page. This has made the organizing effort to gather signatures far less practical. 

South Dakota advocates still managed to qualify an initiative to expand Medicaid, which would provide coverage to tens of thousands of low-income South Dakotans, for the November ballot.

But those same advocates have had to turn their attention to fighting next week’s Amendment C, the measure that increases the threshold for initiatives. Dakotans for Health, a group organizing for Medicaid, opposes the measure. Other groups have also come out against it, including the South Dakota Municipal League, several major health systems, and the state chamber of commerce.

Some Republicans have explicitly acknowledged that they scheduled Amendment C for the June ballot to stall November’s Medicaid expansion proposal.

Conservative anti-tax groups, including Americans for Prosperity, the organization founded by the Koch brothers, have fueled the campaign on behalf of Amendment C. And GOP leaders like Noem are focusing on making the case that Amendment C would forestall tax hikes. 

Despite the GOP’s dominance in this legislature, the state Senate barely approved scheduling Amendment C for the June ballot; it only passed the chamber on a narrow 18 to 17 vote, with many Republicans balking at the proposal. Republican Senator Mike Diedrich said he backed the goal of Amendment C but opposed placing it on the ballot in June. As KELO-TV reported, Diedrich argued that it was “bad faith to cut off the process” that the ballot organizers “entered into in good faith” and was “unfair to the people who are following the laws.”

Troy Heinert, one of only three Democrats in South Dakota’s Senate, said Amendment C was part of “a systematic assault on the will of the people.”

It would be hard for Medicaid proponents to clear Amendment C’s 60 percent threshold, though it may not be insurmountable. The Medicaid initiatives in Missouri, Nebraska, Oklahoma, and Utah received between 50 percent and 54 percent of the vote, but Idaho’s triumphed with 61 percent in 2018. (Idaho was redder than South Dakota in the 2020 presidential election.)

Amendment C also faces a lawsuit on the grounds that it violates the state’s new single-subject requirement. But machinations by the state attorney general’s office delayed the litigation by months, preventing it from coming to a resolution before June 7.

The erosion of direct democracy in South Dakota mirrors how the GOP is reacting to initiatives they dislike elsewhere. According to an analysis last year by the Ballot Initiative Strategy Center, Republican lawmakers filed dozens of bills nationwide to make it harder for voter-initiated measures to make it onto the ballot, and many of them have become law. 

In Utah, after voter-initiated statutes that legalized medical marijuana, expanded Medicaid, and created an independent redistricting commission all succeeded in 2018, the legislature repealed all of the statutes in its next session; they later added new restrictions on the process of gathering signatures, making it more burdensome for organizers. Mississippi’s supreme court shut down the state’s entire ballot initiative process last year while striking down a marijuana referendum. Similarly, after Idahoans approved Medicaid expansion in 2018, the legislature moved to thwart future efforts by greatly increasing the difficulty of qualifying an initiative for the ballot. The Idaho Supreme Court invalidated these restrictions last year, holding that voters’ powers to initiate statutes were “fundamental rights” that the legislature had infringed upon.

Luke Mayville, the co-founder of Reclaim Idaho, an organization that sponsored the state’s 2018 Medicaid expansion initiative, says the successes in Idaho and South Dakota are linked—and so is the backlash from the state legislatures. 

“Successful initiative campaigns in deep-red states are shining a bright light on the refusal of Republican political establishments to address a whole range of urgent issues,” Mayville told Bolts, including the bread-and-butter issues that impact people’s everyday lives. Reclaim Idaho is championing a new initiative this year to increase education funding by $300 million per year.

“Politicians would prefer to avoid accountability for their failure, and that’s why they’re trying to subvert the initiative process,” he added.

This article has been updated to better reflect the history of the onset of the initiative process in 1898.

The post “A Systematic Assault”: GOP Rushes to Change Election Rules to Block Medicaid in South Dakota appeared first on Bolts.

Update (Aug. 4): Amendment 2, the initiative to expand Medicaid, has prevailed.

The opioid crisis has taken a particularly grim toll in Missouri, especially for communities of color. Two years ago, Missouri saw a 16 percent spike in fatal overdoses while the national average trended downward, and the state also has the third highest overdose rate among Black people.

On Aug. 4, Missouri voters will decide whether to expand Medicaid in a ballot initiative. If Amendment 2 passes, it would overhaul Missouri’s approach to addiction by steering more resources toward treatment programs that can counter criminalization. The expansion would also unlock billions in federal funding for health coverage and hospitals and provide coverage to an estimated 230,000 low-income adults and 40,000 children. 

In recent years, voters in a handful of red states have expanded Medicaid through ballot initiatives, overriding conservative officials who have refused to take advantage of the federal Affordable Care Act to extend health insurance to millions of residents. Last month, Oklahoma became the latest to join this trend when voters approved a referendum by 1 percentage point.

The stakes are similar across the board: Economic and racial disparities, coupled with a crisis in rural healthcare, make Medicaid expansion a life and death issue in every state that hasn’t grown the program. Now, nearly 600,000 people in Missouri have filed for unemployment insurance due to the coronavirus pandemic, which means the number of people who would benefit from Medicaid expansion could be even higher than previously thought, with outsized ramifications for anyone who would like to access programs for substance use.

The spread of illicitly manufactured fentanyl, a potent opioid, has hit Black communities in the postindustrial city of St. Louis especially hard. Last year, opioid-related deaths among Black men in St. Louis and St. Louis County increased by 17 percent, even though they dropped by 8 percent in that area overall, according to preliminary data released this week by the Centers for Disease Control and Prevention. 

“In Missouri, we have deaths of despair,” Timothy McBride, a health economist at Washington University in St. Louis, told The Appeal: Political Report. “We have rises in deaths from alcohol, drugs, and suicide—it’s not a pretty picture, and it’s not getting any better.” 

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Robert Riley II knows firsthand how Medicaid expansion could make a difference for people struggling with drug use. He spent time in prison on drug-related charges before co-founding the nonprofit Missouri Network for Opiate Reform and Recovery, otherwise known as the MoNetwork, in 2012.

“My incarceration and substance use experience are my greatest assets today,” Riley told the Political Report. “It allows me to provide empathy and guidance on staying safe to someone actively using, but most of all, I view the person suffering as a human being. And that humanity is what I feel is missing in debates about healthcare, and that’s because of stigma in America.” 

Staff at the MoNetwork drive an old ambulance around St. Louis, distributing overdose-reversal kits, sterile syringes, and other supplies to people who use drugs and are unstably housed. Since the pandemic, they’ve added hand sanitizer, gloves, and masks among the supplies they give away for free. Riley and the MoNetwork have created an oasis of compassion and non-judgement for the communities they serve. 

In addition to supplying tools to prevent overdose and exposure to HIV and hepatitis C, the MoNetwork also refers people to treatment and recovery housing. But the Covid-19 pandemic has strained budgets, limited the availability of treatment slots, and, out of precaution, some facilities stopped admitting new patients, leaving many without the care they need. 

Organizations like MoNetwork can only provide so much support with donations and charity funding. Without a well-funded safety net, they’re left putting Band-Aids on bullet wounds.

“We know that within Missouri’s safety net substance use treatment programs, about 70 percent of people who present for treatment are completely uninsured,” Rachel Winograd, associate research professor at the University of Missouri-St. Louis, told the Political Report. “Having a larger client population that has any type of insurance coverage, including Medicaid, allows programs to help more people.” Winograd said expanding Medicaid would ultimately reduce the number of uninsured people seeking help.

States that expanded Medicaid saw admissions for addiction treatment increase by 113 percent, according to a 2017 study in the Journal of Health Economics. The same study found admissions for medication treatments like methadone and buprenorphine increased by 105 percent. Both medications are considered “the gold standard” for treating opioid addiction and have shown to significantly reduce the risk of fatal overdose. A January 2020 study in the Journal of the American Medical Association found fewer overdose deaths from heroin and illicit fentanyl in states that expanded Medicaid compared to those that did not. 

“Our results suggest that Medicaid expansion might have prevented between 1,678 to 8,132 overdose deaths in the 2015 to 2017 period in the 32 states that expanded Medicaid,” Nicole Kravitz-Wirtz, the lead author of the 2020 JAMA study, told the Political Report. 

Medicaid expansion could also prevent incarceration. A high percentage of people incarcerated have a substance use disorder diagnosis and could benefit from treatment instead of going to jail. 

“If we treat substance use instead of punish people, we’ll see the number of people flowing through our criminal justice system drop. Preventive measures and treatment work better than incarceration, and it saves the state money,” Riley said.

Research cited by McBride found the same trend in other expansion states like Louisiana and Montana, which saw significant cost savings related to behavioral health and the criminal justice system.

“At the end of the day, it comes down to stigma,” Riley said. “We can talk about budgets and cost savings, but until more people have healthcare, better access to treatment, and are treated with dignity, it’ll keep being a struggle to save lives.”

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The push to expand Missouri’s public insurance through a ballot initiative is supported by groups like The Fairness Project, a nonprofit that successfully spearheaded similar campaigns in several other states. Jonathan Schleifer, executive director of The Fairness Project, said expanding Medicaid isn’t just about healthcare.

“It’s also an economic justice issue by removing one of the greatest stressors”—the cost of healthcare—“in a family’s life.” He added, “The pandemic has exposed America’s invisible workers now as ‘essential workers,’ and we’re trying to help them with Medicaid expansion.”

At the moment, Missouri has some of the strictest eligibility criteria for Medicaid in the country. Single men, single women, and married couples are not eligible regardless of their income. To be eligible for Medicaid in Missouri, one must be disabled and not working, or be a parent and earn a yearly income below 20 percent of the poverty line, which for a family of three is a paltry $4,000. 

Expanding Medicaid would drastically change who is eligible for coverage. With Amendment 2, adults ages 19 to 64 whose income is at or below 138 percent of the poverty level—which is $29,973 for a family of three—would qualify.

McBride calls the 190,000 adults who are currently left out of Medicaid in Missouri the “gap population.” He says they are working but are not offered employee health insurance and make too little to qualify for a plan from the federal Healthcare Marketplace. 

“Most of the uninsured are low-income people who have low wage jobs,” McBride, told the Political Report. “If you’re making $12,000 a year, one medical bill could kill you. One visit to the ER for $500, they can’t pay it. One drug they have to pay for is impossible.” 

Like in other states, people in Missouri are more likely to be uninsured if they live in rural areas, which is one of the main drivers behind rural hospitals shutting down across the state. 

“Many of our rural hospitals are hanging on by a thread,” Ryan Barker, the vice president of strategic initiatives at the Missouri Foundation for Health, told the Political Report. “We’ve lost 10 rural hospitals in the last six or seven years … and a lot of that is because they see a higher percentage of uninsured patients.” He added, “Hospitals are not only important access points for residents in rural Missouri, but are often the largest employers in rural areas. If you lose the hospitals, you also lose a lot of jobs.”

Roughly 45 percent of Missouri’s hospitals are located in rural areas. A study published in 2018 found that hospitals in states that expanded Medicaid were more than six times less likely to close than hospitals in non-expansion states. The effect of Medicaid expansion on hospitals was especially strong in more rural areas, where federal funding gave rural hospitals a stronger financial footing.

If Missourians vote to expand Medicaid to low-income and working people, it would become the sixth state where voters bypass Republican leaders through the ballot to expand public health coverage, after Maine in 2017, Idaho, Nebraska, and Utah in 2018, and Oklahoma last month.

A “yes” vote for Amendment 2 would write Medicaid expansion into Missouri’s constitution, limiting the possibility for Republican leaders to block implementation or add stricter eligibility burdens like work requirements. 

In 2017, voters in Maine, another state hit hard by overdose deaths, approved Medicaid expansion, but then-Governor Paul LePage refused to implement the program. The expansion wasn’t enacted until January 2019, after LePage lost his re-election bid to Janet Mills, a Democrat, who ordered the results of the referendum to stand. Mills cited the urgency of the opioid crisis in Maine and a lack of treatment capacity as some of the primary reasons to expand Medicaid. 

“Americans in even the reddest of states want healthcare, and they’re willing to put it in their constitution to protect it from political meddling,” Schleifer told the Political Report. “That’s why we put expansion on the ballot for the people to decide. We’re talking about life and death differences in expansion versus non-expansion states.”

The post Missouri Voters Could Expand Medicaid and Curb the Overdose Crisis appeared first on Bolts.

Last week, while other states considered how to protect people losing healthcare coverage and how to decarcerate in light of COVID-19 dangers, New York took steps in the opposite direction.

Its 2020 budget, championed by Governor Andrew Cuomo, cuts billions from the Medicaid program, which covers low-income New Yorkers, including slashing payments to hospitals. It also rolls back last year’s landmark bail and discovery reforms, which law enforcement groups kept combating after their passage; it expands the cases in which judges can keep people detained pretrial, and loosens the requirement that prosecutors promptly hand over discovery material with defense counsels.

Some progressive lawmakers fought the bill in the broader budget package that dealt with these measures (Assembly Bill A9506B/Senate Bill 7506B). Assemblymember Yuh-Line Niou denounced it as an “austerity budget” in a floor speech. “This pandemic has put a harsh spotlight on a reality in which not enough has changed to meet the needs of today,” she said.

Still, these measures were passed on the strength of the legislature’s Democratic majorities. The budget was negotiated between Cuomo, State Senate Majority Leader Andrea Stewart-Cousins, and Assembly Speaker Carl Heastie, all of whom are Democrats. GOP lawmakers opposed it.

The emerging ideological fault lines within the Democratic Party were on display. A quarter of Democratic Assemblymembers opposed this bill.

In the Senate, only five Democrats out of 40 voted against SB 7506B. All five of these senators joined the legislature after successfully challenging incumbents from the left in Democratic primaries. All but one did so in 2018, the state’s most recent legislative cycle.

Three of the five—Alessandra Biaggi, Zellnor Myrie, and Jessica Ramos—won that year by ousting former members of the Independent Democratic Caucus (IDC), a group of lawmakers who chose to caucus with the GOP and who by and large supported tougher-on-crime bills. When I asked Biaggi and Myrie about their goals shortly after their wins, both mentioned bail reform, and last week both voted to preserve the changes made in 2019. A fourth, Julia Salazar, won in 2018 with the support of Democratic Socialists of America. The fifth, Gustavo Rivera, ousted an incumbent who was a member of an IDC-like group back in 2010. 

This week, I talked to Biaggi about why she voted against S7506B and about her concerns regarding the state cutting Medicaid and rolling back criminal justice reforms. The Q&A is available below.

Biaggi, who represents parts of Bronx and Westchester counties, denounced the budget’s “fundamental failure and injustice.” She also made the case that it would harm New Yorkers already most vulnerable to COVID-19.

Regarding Medicaid, she explained that her Bronx constituents already face higher rates of medical issues, and will suffer from cuts to public spending. 

“All that we had to do was ask the ultra-millionaires and billionaires to pay a little bit more so that we could prioritize communities in our state that have been hurt the most, the most vulnerable,” she argued, alluding to the decision to keep education funding flat. Cuomo has said New York faces fiscal difficulties, but he resisted proposals to raise revenue by taxing the ultrawealthy, for instance through a pied-à-terre tax. 

With the bail reform retreat, Biaggi regretted that more people will be detained, including over low-level offenses, if they are deemed to be “repeat offenders.” She also criticized the decision to loosen discovery reform. “Pulling that ripcord while we’re trying to inform our constituents and community does not do justice to the ultimate outcome that we hope to see,” she said, “which is a reduction of people going to jail in communities of color, in low-income communities, and of the criminalization of poverty.”

Michael Gianaris, a Democratic senator who represents parts of Queens and was the architect of the 2019 bail reform law, voted in favor of S7506B.

“I am not happy with the bail changes, which were included in a state budget bill controlled by the Governor,” Gianaris said in a written statement through a spokesperson when asked for his views on the bill’s bail component. “The changes ultimately approved would have been far worse if earlier drafts pushed by reform opponents were enacted. We successfully pushed back against some of their worst elements.” 

According to the Queens Eagle, reform advocates were frustrated by Gianaris’s silence earlier this year, when opponents of bail reform were battering the changes; in March, he did not join a letter signed by 40 other lawmakers who warned that “bail reform rollbacks … are especially irresponsible at a time when they would exacerbate a public health crisis.” 

Biaggi, whose district contains the Rikers Island complex, signed that letter. She told me this week that she is concerned that the pandemic could still be raging when this new law goes into effect, putting more people in jail at the worst possible time. Instead, she wants New York officials to urgently reduce the population held on Rikers, where a public health catastrophe is underway. When Biaggi called for higher-risk people to be released from Rikers mid-March, there were two confirmed cases there. There are now more than 200.

“When we look back on this time, what we’re going to be judged by is how we protected those who are the most vulnerable, and this population falls in that category,” she said.

The Q&A was condensed and lightly edited for clarity.

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You were one of five Democratic senators to oppose the portion of New York’s budget that made some significant spending cuts and touched on criminal justice issues. What were the important factors in your vote?

This year, the Education, Labor and Family Assistance budget bill, commonly referred to as ELFA, was the equivalent of what they call the “big ugly.” This was the bill that I think epitomized the fundamental failure and injustice of the whole entire budget for this year. It included flat levels of funding for our schools, rolling back the transformational change that we made to the criminal justice system last year, to bail and discovery, and then the cuts to Medicaid in the billions, while failing to consider revenue raisers. Collectively this epitomized negligence. 

The budget is a reflection of our values and our priorities as a state. All that we had to do was ask the ultra millionaires and billionaires to pay a little bit more so that we could prioritize communities in our state that have been hurt the most, the most vulnerable. And yet what we did was not only not revenue raisers, but we made cuts. 

I’m very proud of my “no” vote on the ELFA bill. It was not an easy decision to make because there were things in the bill of course that I cared about, like surrogacy that I had fought really hard for. But at the end of the day, when you are weighing all of these very important issues, you have to look at the scale and where it balances toward. 

Many who watched the budget unfold were taken aback by the choice to cut Medicaid in the midst of a health crisis. How do you view this choice and the impact it could have?

The cuts were framed as savings. It’s not about savings. It’s about making cuts to hospitals during a pandemic. When we think about the Medicaid cuts, MRT2, which is the Medicaid Redesign Team 2, they are going to hurt the most vulnerable. The cuts that are being made are to the indigent care pool hospitals, which are the hospitals that are the ones who help those who are Medicaid recipients or those who don’t have health insurance. 

I represent the Bronx and Westchester County, and the Bronx has been 62 out of 62 [counties] for health outcomes. The highest rates of asthma, diabetes, hypertension, all are in the Bronx. In fact, some of the highest rates of asthma are in the South Bronx, which is in District 34. Those underlying conditions and potential comorbidities, if someone does contract COVID-19, will mean that those who suffer from those underlying conditions will be more likely to die. 

Lastly, there was a portion of the budget for MRT2 that directly impacts so many providers in my district. It cuts the 340D pharmacy program, which allows providers to provide medication and services to low-income Bronxites. It basically serves Medicaid patients. The fact that we would do that in a time like this is just unconscionable. 

You supported bail reform in 2018, and then in the legislature. What is your assessment on how bail reform was implemented this year, and what worries you about this rollback?

The changes made to bail this year did nothing to address the underlying injustice that is inherent to cash bail: Cash bail inherently is unjust. It allows for those with means to not go to jail while they’re waiting for their trial, and to actually not have to sit in jail, and those without means to have to sit in jail. Let’s be very clear that the system of cash bail criminalizes poverty, period. There’s no other way to look at it. 

Last year, when we passed our criminal justice reforms, not only was I so proud to vote for it, but I was especially proud because I also represent Rikers Island. When we look at the bail piece, when we look at the reforms of the discovery system, we’re trying to even the playing field and balance the scales of justice. 

I felt very disappointed this year because the rollbacks were, I felt, very unjust. These reforms, in my opinion, will have negative impacts to places that I represent, which includes the Bronx, Mount Vernon, and other areas that have historically have had high rates of incarceration. 

When we look at what we did this year, it’s easy to get caught up in the technicalities of the various crimes that were added. The reality is that what we did was we allowed for, quote unquote, repeat offenders to be criminalized for things that are the equivalent of what Kalief Browder went to Rikers Island for. I specifically asked the question, “If I were to steal a backpack one time, and then I was to steal a backpack a second time, would I end up in Rikers,” and the answer was yes. Even though that’s not the necessary equivalent of what he was accused of having done, even though he did not do that, the point I was trying to make was why are we rolling back the very thing that we literally stood on bail reform for. It does not make any sense. 

The repeat offenders piece of this budget allows the judge to request bail if someone was arrested for what’s called a Class A misdemeanor or felony while they’re on release for a different Class A misdemeanor and felony, if both crimes caused harm to a person or property. Theft of a backpack or graffiti includes that class of things. I really feel that is inherently in opposition to what we are trying to accomplish. What we will see is that the 90 percent number [of people who get released pretrial] will decrease. I don’t know how much, but it will I think significantly because it’s very easy to hold someone accountable for these types of things, graffiti, theft of a loaf of bread.

Bail reform was a celebrated accomplishment in 2019, just a year ago, and it was only implemented in January. The pushback and concessions were nearly immediate. How do you explain this change?

What we did last year was so monumental and was such a long time coming. What happened in January, and the months leading up to that, was really just a narrative war, communications war, that we lost. We still to this day don’t know all the data of what exactly the reforms have done or have impacted. When we look at what the system has done historically in New York and the United States, there is still a significant number of people who don’t understand what criminal justice reform is. So it takes time to educate people. It takes time to humanize issues that people may never have experienced in their lives. And from January to March, when the law was effective, we didn’t even have the sufficient time to do all of that education. Now, one could argue that last year from March until January, we could have done that, and a lot of us did. But this kind of change, this systematic fundamental change takes time. 

Pulling that ripcord while we’re trying to inform our constituents and community does not do justice to the ultimate outcome that we hope to see, which is a reduction of people going to jail in communities of color, in low income communities, and of the criminalization of poverty. 

I look at that portion of the budget and I think about the moment that we’re in, which is a pandemic. We have seen hundreds of people test positive at Rikers Island. What we are going to see after the laws take effect in 90 days is an increase in our jail population. And we cannot be assured that the pandemic is going to have come and gone by the time these laws take effect. 

Three weeks ago, you wrote a letter that called on New York to adopt emergency measures to release people from Rikers Island. There are now hundreds more confirmed COVID-19 cases than then. What do you think of  the management of this Rikers crisis, and what can still be done to protect people?

Continuing testing is important, although it’s not determinative. I have called for a testing site to be placed on Rikers Island specifically for inmates as well as for the corrections officers that have called for increased doctors, as well as health options for those who are in Rikers. Now I have to just say that I’ve been told that there is adequate health care for individuals or inmates who are experiencing symptoms, that they’re placing certain individuals of symptoms into a certain area. But we have already lost the first person incarcerated at Rikers to COVID-19. His name is Michael Tyson, he was 53 years old. He was held at Rikers Island for a technical parole violation, a whole other injustice we could probably spend another day talking about. His death will not be the last. 

There is, again, no reason why those who are part of this vulnerable population who are in Rikers Island awaiting trial should be in Rikers Island at this time. It is dangerous, not only to others who are there, it is dangerous to the corrections officers, it is dangerous to our society, and it is dangerous to New York to really continue to allow this to happen. 

I called in a letter with others I serve with to relieve the vulnerable populations that are in Rikers. The mayor’s office has begun to do that, the governor’s office, I believe, has also worked with the mayor’s office to do that. But it’s not enough. If you’re looking at what the doctors or scientists are saying, they’re saying that self isolation and quarantine is one of the ways to reduce the spread of COVID-19. A jail is the complete antithesis of what doctors and scientists are calling for. That was part of the equation as to why I made the decision to write that letter. 

When we look back on this time, what we’re going to be judged by is how we protected those who are the most vulnerable, and this population falls in that category. So I will continue, not only because of my responsibility as the state senator for Rikers Island but as a human being in this moment, to just acknowledge the fact that these are people who don’t have a voice and it is our responsibility to provide that for them.

The post “Unconscionable”: New York Senator Denounces State’s Medicaid Cuts and Criminal Justice Reform Rollbacks appeared first on Bolts.

Reeves is staunchly opposed to expanding Medicaid as provided under the Affordable Care Act, and he ran ads attacking his Republican opponent Bill Waller for supporting the idea. “Bill Waller would expand Obamacare in our state,” said one ad. “Three hundred thousand more people on welfare.”

An estimated 300,000 Mississippians are in a coverage gap due to the state’s refusal to expand Medicaid. They are ineligible for public insurance under current rules and yet too poor to qualify for government subsidies to purchase a private plan.

Reeves next faces Attorney General Jim Hood, the Democratic nominee who unlike Reeves favors expanding Medicaid. “That’s insane for us not to take care of those folks, and keep those hospitals open,” he told the Clarion Ledger. 

Mississippi has one of the country’s highest rates of uninsured residents, alongside other states that have not expanded Medicaid. Having a minimum wage job is enough to make one too wealthy to qualify for Medicaid under the current rules, according to Mississippi Today. Poor access to healthcare is also furthering a dire crisis in the state’s rural hospitals. A report published by the Mississippi Center for Justice in 2015 documents that poor areas with a higher share of uninsured residents are also facing a severe shortage of medical providers, which impedes everyone’s access to treatment whether or not they have insurance.

“Mississippi is at the bottom of the pile when it comes to issues of need for access to quality healthcare,” Jennifer Riley Collins, the former executive director of the ACLU of Mississippi and the Democratic nominee for attorney general this year, told the Appeal: Political Report last week. “Citizens of the state of Mississippi are dying, literally, because they can’t access healthcare.”

A lack of insurance coverage also blocks people with substance use or mental health issues from receiving treatment, which makes them likelier to interact with law enforcement. Mississippi is essentially using its carceral system as its response to matters like the opioid crisis. 

Expanding Medicaid could enable more of a public health approach to issues presently funneled through prisons and jails. Stacey Abrams, Georgia Democrats’ gubernatorial nominee in 2018, ran on a platform that called Medicaid expansion a “vital investment” in “public safety,” a connection that studies have documented. 

The Hood campaign told the Political Report that criminal justice reform was a factor in the attorney general’s support for expanding Medicaid in connection to mental health. “Jim Hood recognizes the critical role health coverage plays in increasing access to care for Mississippians suffering from mental health issues, as well as the impact mental health care has in reducing incarceration rates and increasing public safety in Mississippi communities,” the campaign said in a statement via email. “Certainly accepting federal funding to increase access to care would help these people receive appropriate treatments, reduce incarceration rates, and increase public safety in our communities. By providing mental health care out in the communities, we will be able to also treat those re-entering society.”

Hood has long denounced as inadequate the funds that Mississippi devotes to mental health services; he has called on the legislature to allocate more money, and predicted lawsuits over health care failings. In his role as attorney general this year, however, he has defended the state in court against a lawsuit that challenges whether it is doing enough for people to access services in community settings. The Reeves campaign did not respond to a request for comment on their views on the connection between the criminal legal system and the Medicaid expansion.

A governor who supports this policy may not be sufficient to achieve expansion (Mississippi Today reports that expansion “likely” requires legislative action), but could facilitate negotiations already in progress between state actors and add pressure on lawmakers.

In Mississippi as elsewhere, many formerly incarcerated people face health issues but do not qualify for Medicaid under current eligibility rules.

But they will not be able to weigh in come November. Ten percent of the voting-age population will be barred from voting in this governor’s race due to Mississippi’s harsh Jim Crow-era rules regarding felony disenfranchisement.

The election is further shadowed by another Jim Crow-era law, which requires that a candidate win a majority of the state’s 122 House districts in addition to winning the most votes; otherwise, the election is thrown to the legislature. The rule effectively gerrymanders the governor’s race.

The post In Mississippi, Candidates for Governor Split on Expanding Medicaid appeared first on Bolts.

The Idaho ballot initiative to expand Medicaid got a lift in September when the Idaho Sheriffs Association endorsed it, citing in part the effect it could have in relieving the criminal justice system. “Their endorsement was a big boost to our campaign,” Luke Mayville, a founder of Reclaim Idaho, the group that put this initiative on the ballot, told me. “They’ve seen the extent to which drug addiction problems are interwoven with criminal justice and incarceration, and they believe that the kind of drug treatment and addiction treatment that Medicaid would provide would be an aid to their effort to reduce crime.”

Calls for criminal justice reform and efforts to expand Medicaid boosted one another nationwide during the 2018 campaign.

Stacey Abrams, Georgia Democrats’ gubernatorial nominee, explicitly connected these dots in a detailed criminal justice reform platform that featured the expansion as a core plank. “When individuals receive Medicaid and can finally access mental health and substance abuse treatment in their communities, crime rates drop,” the document states, describing the expansion as “a vital investment in public health and public safety.”

The Affordable Care Act (ACA) significantly expanded Medicaid eligibility for low-income people. But some states have refused to expand the program, depriving millions of the public insurance that the ACA was meant to provide. This harms people released from incarceration. “They most likely will be uninsured because they won’t come out and have a job with employer benefits, and they’re unlikely to be able to afford private insurance,” Robin Rudowitz, an associate director for the Program on Medicaid and the Uninsured at the Kaiser Family Foundation, told me. “Without coverage, those individuals do not have access to affordable, comprehensive medical care.” It also leaves many individuals who experience mental health or addiction issues unable to afford treatment, making them more vulnerable to punitive policies.

Stacey Abrams fell short in Georgia. But voters in Idaho, Nebraska, and Utah all voted to expand Medicaid via referendums.

Molly McCleery, the deputy director of the health care program of Nebraska Appleseed and an adviser for Nebraska’s expansion campaign, and Mayville both said that criminal justice reform messaging did not feature prominently in their states’ campaigns. But they both also believe that it proved potent with conservative voters worried about the opioid crisis and “the severity of drug addiction,” as Mayville put it.

Mayville recalls encountering criticism that expansion meant providing public benefits to people who are addicted to drugs. “I made the case that far from it being a problem that people on drugs would be on Medicaid, that’s one of the main positives, a tool to fight drug addiction,” Mayville said. “Once I framed it in terms of, we’re trying to give people a way out of addiction, rather than just simply giving benefits to people who are wallowing in addiction, once I framed it as these benefits giving people a way out of addiction and the incarceration that comes with it, I found that to be a good argument.”

Similarly, McCleery told me that the opioid crisis came up during community presentations in Nebraska, and that expansion proponents emphasized the care that Medicaid coverage enables.  “One thing people really understand is that if you don’t have insurance you are relying on safety net services, a patchwork of services, and you may not get the full scope of treatment you would get if you had insurance,” McCleery said. She noted that this resonated in rural areas, which have been hit by hospital closures nationwide and in Nebraska.

The successful referendums are just the beginning for Idaho, Nebraska, and Utah. Beyond the questions about how officials will implement them, eligible individuals who interact with the criminal justice system still encounter obstacles to coverage. The Kaiser Family Foundation has released multiple reports on how to facilitate actual access to care, for instance by helping people sign up before they are released or suspending rather than terminating their coverage while they are incarcerated. “The Medicaid expansion created more incentives for states to link [the justice-involved] population to coverage and care,” Rudowitz said.

The post How Medicaid Expansion and Criminal Justice Reform Boosted Each Other in 2018 appeared first on Bolts.