Maine voters will have an opportunity to vote to expand Medicaid

AP: On Election Day, Maine voters will decide whether to expand Medicaid in their state via a ballot initiative. Voters in Maine will decide on this Election Day “whether to join 31 other states and expand Medicaid under former President Barack Obama’s Affordable Care Act,” The Associated Press (AP) reported. As AP noted, “It is the first time since the law took effect nearly four years ago that the expansion question has been put to voters.” From the October 31 article:

On Nov. 7, voters in Maine will decide whether to join 31 other states and expand Medicaid under former President Barack Obama’s Affordable Care Act. It is the first time since the law took effect nearly four years ago that the expansion question has been put to voters.

The ballot measure comes after Maine’s Republican governor vetoed five attempts by the politically divided Legislature to expand the program and take advantage of the federal government picking up most of the cost. [The Associated Press, 10/31/17]

Local TV in Maine omitted information about the key benefits of expansion from their reports

Media Matters analyzed eight months of local news reporting on the ballot initiative to expand Medicaid. A Media Matters analysis found that, in total, local TV news networks in Portland, ME, covered the initiative in 49 segments between February 21, when the initiative was approved, and October 21. Those segments routinely omitted important information about the benefits of expanding Medicaid in Maine:

• Only about 30 percent of local news segments in Portland, ME, mentioned potential coverage gains under Medicaid expansion.
• No segments discussed potential coverage gains by rural Mainers.
• Only one segment mentioned the overall health benefits of expanding Medicaid.
• Only three segments mentioned the potential financial benefits for rural hospitals. 
• No segments mentioned the educational benefits for children of expanding Medicaid.
• Only three segments discussed the budgetary benefits for states that expanded Medicaid. 
• No segments mentioned increased financial security for low-income people in states that expanded Medicaid.
• No segments mentioned the correlation between Medicaid expansion and lower premiums.
• No segments mentioned the impact expanding Medicaid has on opioid addiction.
• No segments mentioned the impact of expanding Medicaid on mental and behavioral health treatment.

CBPP: Expanding Medicaid “would provide Medicaid coverage to more than 70,000 low-income Mainers.” The Center on Budget and Policy Priorities (CBPP) estimated that expanding Medicaid in Maine “would provide Medicaid coverage to more than 70,000 low-income Mainers.” [Center on Budget and Policy Priorities, 10/25/17]

Only about 30 percent of local news segments in Portland, ME, mentioned potential coverage gains under Medicaid expansion. A Media Matters analysis of local TV coverage of the Medicaid expansion initiative in Portland, ME, found that of 49 segments that discussed the policy over the course of eight months, only 15 segments -- or 30.6 percent -- mentioned the potential coverage gains for citizens if Maine expanded Medicaid.

CBPP: In states that expanded Medicaid, “nearly 1.7 million rural Americans have gained coverage through the Medicaid expansion.” “Nearly 1.7 million rural Americans have gained coverage through the Medicaid expansion,” according to CBPP. The center also explained that in states that expanded Medicaid, “rural residents make up a larger share of expansion enrollees than of the states’ combined populations.” [Center on Budget and Policy Priorities, 6/23/17]

No segments discussed potential coverage gains by rural Mainers. Of the 49 segments, none mentioned potential coverage gains for those who live in rural parts of Maine.

Council of Economic Advisers: Residents in states that expanded Medicaid are more likely to say they are in good or excellent health than residents in other states. A 2014 analysis by then-President Barack Obama’s Council of Economic Advisers found that “having insurance coverage improves overall health.” By expanding Medicaid in the 24 states that had not yet done so at that point, the report estimated, “757,000 additional people would report being in excellent, very good, or good health.” The report also found that “states that have already expanded Medicaid will achieve this outcome for 575,000 people.” [The Council of Economic Advisers, 7/2/14]

Only one segment mentioned the overall health benefits of expanding Medicaid. Of the 49 total segments, only one -- or 2.0 percent -- mentioned the potential health benefits that correlate with expanding Medicaid.

CBPP: Expanding Medicaid has “substantially improved rural hospitals’ finances.” CBPP found that expanding Medicaid has “substantially improved rural hospitals’ finances,” partially because “the Medicaid expansion significantly reduced rural hospitals’ uncompensated care costs.” Additionally, CBPP stated that expanding Medicaid has “improved all hospitals’ operating margins” and “excess margins … but the effect was particularly pronounced in rural areas.” From the CBPP report (citations removed):

Health coverage gains in states that expanded Medicaid to low-income adults have substantially improved rural hospitals’ finances. First, the Medicaid expansion significantly reduced rural hospitals’ uncompensated care costs — services for which hospitals are not reimbursed by an insurer or the patient. Between 2013 and 2015, rural hospitals’ uncompensated care costs fell 43 percent in Medicaid expansion states, compared to 16 percent in non-expansion states. Uncompensated care costs among rural hospitals declined as a share of total costs from 5.3 percent to 3.2 percent in expansion states, while only declining from 6.8 percent to 6.1 percent in non-expansion states. Uncompensated care costs have been shown to strain hospital budgets, reduce profit margins, and contribute to hospital closings.

The Medicaid expansion also significantly increased Medicaid revenue among rural hospitals. Since 2013, Medicaid revenue as a share of total hospital revenue rose by 33 percent in rural hospitals in expansion states, compared to just 1.1 percent among rural hospitals in non-expansion states. That 33 percent increase equates to $2 million in higher annual revenue to the average rural hospital due to the Medicaid expansion.

The Medicaid expansion improved all hospitals’ operating margins (i.e., the difference between their revenue from providing services to patients and their total operating expenses) and excess margins (the difference between revenue from all sources, including donations, parking fees, vending machines, etc., and total operating expenses), but the effect was particularly pronounced in rural areas. Rural hospitals in expansion states increased their operating margins by 4.0 percentage points more, and their excess margins by 2.3 percentage points more, than rural hospitals in non-expansion states. Gains were particularly pronounced among small rural hospitals with fewer than 100 beds in expansion states, where operating margins rose by 4.5 percent. The Medicaid expansion led to smaller gains in operating and excess margins in urban areas, of 1.0 percentage points and 0.9 percentage points, respectively. [Center on Budget and Policy Priorities, 6/23/17]

Only three segments mentioned the potential financial benefits for rural hospitals. Of the 49 total segments, only three -- or 6.1 percent -- mentioned the financial benefits for rural hospitals in states that expanded Medicaid.

Families USA: Expanding Medicaid leads to “higher educational attainment” for children. In a blog post, Families USA summarized a report finding that expanding Medicaid allows children “to reap the benefits associated with health coverage,” which go beyond health care and include “higher educational attainment and greater economic opportunities for children, and the creation of a more skilled workforce.” From the July 8, 2014, blog post:

The expansion of Medicaid gives parents options for affordable health coverage. When more parents enroll in health insurance, so do their kids, allowing them to reap the benefits associated with health coverage.

These benefits extend beyond access to health care, as the Cornell and Harvard researchers note in their study: “[T]he long-run returns to providing health insurance access to children are larger than just the…gains in health status.”

Those returns include higher educational attainment and greater economic opportunities for children, and the creation of a more skilled workforce. With these findings, it should be clear to policymakers that not only does expanding Medicaid close the coverage gap – it also increases the payback on their education investment. [Families USA, 7/8/14]

No segments mentioned the educational benefits for children of expanding Medicaid. Of the 49 total segments, none mentioned the educational benefits for children in states that expanded Medicaid.

Robert Woods Johnson Foundation: States that expanded Medicaid “report financial benefits through savings and revenue gains.” “As a result of Medicaid expansion, states continue to report financial benefits through savings and revenue gains,” a study by the Robert Woods Johnson Foundation found. As the report explained, the saving and revenue “can be used to finance other state spending priorities or to offset much, if not all, of the state costs of expansion.” [Robert Woods Johnson Foundation, March 2016]

Only three segments discussed the budgetary benefits for states that expanded Medicaid. Of the 49 total segments, only three -- or 6.1 percent -- mentioned budgetary benefits states received after expanding Medicaid.

KFF: “Research suggests that Medicaid expansion improves the affordability of care and financial security among the low-income population.” The Kaiser Family Foundation (KFF) summarized research that “suggests that Medicaid expansion improves the affordability of care and financial security among the low-income population.” Among the studies, KFF noted, several found “expansion states have experienced greater reductions in unmet medical need because of cost than non-expansion states.” Additionally, “multiple studies found larger declines in trouble paying medical bills in expansion states relative to non-expansion states.” [Kaiser Family Foundation, 6/20/16]

No segments mentioned increased financial security for low-income people in states that expanded Medicaid. Of the 49 total segments, none mentioned the increased affordability of care and financial security low-income people found in states that expanded Medicaid.

NY Times: Expanding Medicaid “could lower insurance prices for everyone else.” The New York Times’ Margot Sanger-Katz summarized a study by the Department of Health and Human Services which found “insurance in the marketplace for middle-income people cost less in the places that had expanded Medicaid” in 2015. From the August 25, 2016, article:

The Obama administration for years has been pleading with states to expand their Medicaid programs and offer health coverage to low-income people. Now it has a further argument in its favor: Expansion of Medicaid could lower insurance prices for everyone else.

A new study published by in-house researchers at the Department of Health and Human Services compared places that have expanded their Medicaid programs as part of Obamacare with neighboring places that have not. They found that, in 2015, insurance in the marketplace for middle-income people cost less in the places that had expanded Medicaid.

By comparing counties across state borders, and adjusting for several differences between them, the researchers calculated that expanding Medicaid meant marketplace premiums that were 7 percent lower. [The New York Times, 8/25/16]

No segments mentioned the correlation between Medicaid expansion and lower premiums. Of the 49 total segments, none mentioned the correlation between states that expanded Medicaid and states that had lower premiums.

State Health Reform Assistance Network: States that expanded Medicaid have the “greatest opportunity” to address opioid addiction. “Medicaid is the most powerful vehicle available to states to fund coverage of prevention and treatment for their residents at risk for or actively battling opioid addiction,” according to a report by the State Health Reform Assistance Network, a project of the Robert Wood Johnson Foundation. From the July 2016 report:

States are grappling day to day with the vast and deadly public health crisis. Medicaid is the most powerful vehicle available to states to fund coverage of prevention and treatment for their residents at risk for or actively battling opioid addiction. Through federal flexibility, states can create strategies that meet their specific needs, designed to augment other efforts underway. The greatest opportunity to address this crisis is in those states that have elected to expand Medicaid, given the greater reach of the program, additional tools available, and the increased availability of federal funds. [State Health Reform Assistance Network, July 2016]

No segments mentioned the impact expanding Medicaid has on opioid addiction. Of the 49 total segments, none mentioned the impact Medicaid expansion has on addiction treatment for opioid use.

GAO: Medicaid expansion enrollees in three states “could more easily access treatment” for mental or behavioral health issues than when uninsured. A report from the U.S. Government Accountability Office (GAO) found that in Iowa, Washington, and West Virginia, “compared to being uninsured, expansion enrollees could more easily access treatment, such as community-based mental health services and behavioral health prescription drugs.” [United States Government Accountability Office, June 2017]

No segments mentioned the impact of expanding Medicaid on mental and behavioral health treatment. Of the 49 total segments, none mentioned the impact of Medicaid expansion on mental health treatment.

Sinclair stations were less likely to cover the Medicaid expansion ballot initiative than other networks

Sinclair-owned networks aired only eight segments about the potential Medicaid expansion over the course of eight months. Over the eight-month study period, the two Sinclair-owned stations in Portland, ME, CBS affiliate WGME and Fox Broadcasting Co. affiliate WPFO, aired merely eight segments discussing the initiative to expand Medicaid in Maine. In contrast, the two stations not owned by Sinclair, ABC affiliate WMTW and NBC affiliate WCSH, aired 30 segments and 11 segments on the topic, respectively. [Portland Press Herald, 7/30/17]

Methodology

Media Matters searched iQ media for mentions of “Medicaid” and all iterations of the word “expand” on the ABC, CBS, NBC, and Fox Broadcasting Co. affiliates in Portland, ME. We included segments in this study that occurred between February 21, when the ballot initiative was approved, and October 21. We included segments where the stated topic of discussion was the Medicaid expansion and then coded for the following topics:

• how expanding Medicaid would provide coverage for people in Maine;

• the impact of expanding Medicaid on rural Americans;

• the health benefits of expanding Medicaid;

• the impact of Medicaid expansion on rural hospitals;

• the educational benefits of expanding Medicaid;

• the benefits of expanding Medicaid on state budgets;

• the impact expanding Medicaid has on the financial security of low-income Americans;

• the effects of expanding Medicaid on premiums;

• the impact of Medicaid expansion on addiction treatment; and

• the impact of Medicaid expansion on mental health treatment.

Steve Morris contributed research to this piece.