Protestors hold a sign that reads "Respect Democracy Our Vote Matters"
Utah lawmakers are pushing a Medicaid expansion repeal bill. Voters are angry. The Fairness Project

In many states, ballot initiatives on expanding Medicaid, limiting gerrymandering, and raising the minimum wage swept to victory in November. Now lawmakers are doing their best to reverse them.

Updated: February 12, 2019

In November, more than half of Utah’s voters approved a bill to expand Medicaid statewide. Last week, Utah’s House of Representatives voted on a new bill, this time to effectively repeal that expansion. Yesterday, the Senate approved it, and Republican Governor Gary Herbert signed it, too.

It’s a similar story from Maine to Idaho. A raft of states passed progressive ballot measures seemingly at odds with their more conservative legislatures and governors; now those lawmakers are taking steps to hedge or even cancel popular initiatives to expand healthcare, end partisan redistricting, decriminalize cannabis, and increase the minimum wage. This conservative backlash highlights the growing role these initiatives play in cities and states where gridlock and gerrymandering can decide outcomes over the popular vote.

“It’s not a new phenomenon by any means,” Josh Altic, who tracks ballot measures for Ballotpedia, told CityLab in October. But winning initiatives are facing challenges with increasing frequency. “I haven’t seen this much brashness on the part of legislative bodies in the six years I’ve been covering these, or even in the last decade or so.”

That’s fine with some critics of ballot initiatives, on both the left and the right. Many believe these measures shouldn’t carry the legislative weight they do at all. Some measures are sponsored by corporations, as the money it takes to get one on the ballot—much less win one—grows each year. Others are said to be flawed from conception, hurriedly pushed through to the polls via petition. Any of these criticism can be used for politicians to reverse, stall, or restrict the reach of these laws.

“What we’ve seen is that politicians who cannot win with voters at the ballot box try to undermine the will of voters where they do have their power,” said Jonathan Schleifer, the executive director of the Fairness Project, which advocated for Medicaid and minimum wage expansions. “If the system is sick, we’re trying to heal it by going straight to voters. It’s no surprise that the virus is acting up.”

Challenges to Medicaid

Utah: All Utahns earning up to 138 percent of the federal poverty level were expected to gain Medicaid coverage on April 1, after an expansion initiative passed on Election Day with 53 percent of the vote. But Republican lawmakers in Utah are arguing that Proposition 3 will cost the state too much money to implement, even after a $90 million sales tax increase. Instead, Senate and House leaders are pushing SB96, a smaller Medicaid expansion bill that covers only those up to 100 percent of the poverty level, which is around $16,750 for an individual.

With this stab at compromise, says Andrew Roberts, a spokesperson for Utah Decides, an organization fighting to enforce the expansion bill, the legislature is “saying that they’re fulfilling the will of the people by not fulfilling it.”

Advocates argue that not only will the repeal bill deprive low-income citizens of much-needed health coverage, it will ultimately be more expensive for the state. Under the original expansion, Utah would cover only 10 percent of the costs of the insurance, with the other 90 percent coming from the feds. Under the stripped-down version, however, the state would be on the hook for the standard 30 percent—unless the federal government approves a waiver to provide extra funding for the partial expansion. No other state has received a waiver of this kind. “I think this is a mighty big gamble to take,” says Roberts.

According to a statement from the Fairness Project, if the Trump administration rejects the plea for extra funds, the bill commits the state to a 70-30 split, in effect paying “more money to cover fewer people than Utahns voted for.” If Washington does approve the waiver, however, Utah’s success could embolden other states to take similar measures, as the New York Times reports.

After Utah’s Senate approved SB96—amid bipartisan dissent—the repeal bill was swiftly signed by Governor Herbert on Monday night. “They’re moving very quickly and quietly to pass this, because they know it’s not popular with voters,” said the Fairness Project’s Schleifer.

Idaho: Last week, Idaho’s Supreme Court upheld the state’s Medicaid expansion against a challenge brought by a conservative think tank. The Idaho Freedom Foundation insisted that the measure gave too much authority to the federal government; the majority opinion described that line of argument as “unpersuasive.” The court’s decision clears the way for Medicaid expansion in the state, but the ballot measure, which passed with the support of more than 60 percent of Idaho voters in November, still faces hurdles. Republican lawmakers are considering a number of restrictions as they implement Proposition 2.

Idaho is debating now whether to pass a clean Medicaid expansion or tack on asterisks that could add copay requirements, lifetime limits, and waivers. During a hearing on Friday before the legislature, Idaho residents weighed in on these conditions, namely the work requirements proposed for low-income adults newly eligible for Medicaid. One Boise resident, who described the difficulties that she faced when seizures forced her to quit her job as a behavioral therapist, suffered a seizure episode as she testified, according to the Idaho Statesman. Another Boise resident said that she would not be able to take her doctor’s advice and seek preventive surgery for breast cancer without the Medicaid expansion. People fighting the expansion, including members of the Idaho Freedom Foundation, told lawmakers state spending on Medicaid has skyrocketed over the last two years.

While Idaho Governor Brad Little has pledged that the state would implement the measure if it passed, he has also said it would be done “in an Idaho manner”—meaning that work requirements and other limits may be part of the bargain. Thousands of Medicaid recipients in Arkansas lost their coverage after the state implemented work requirements.

Nebraska: Cornhusker conservatives aren’t mounting an end-run around the successful state ballot vote to expand Medicaid in Nebraska. Nebraska Governor Pete Ricketts told residents during his State of the State address on January 15 that he hopes to have a Medicaid expansion plan to file with the federal government by the April 1 deadline set by the ballot measure. But there are a number of questions to answer about how to fund the state’s obligations under Medicaid.

Currently, the federal government requires states to pay for 13 types of healthcare services under Medicaid, from pregnancy to hospice care. Nebraska covers an additional 19 services that are considered optional, according to the Scottsbluff Star Herald, including dental care and prescription drug coverage. Expanding the state’s budget to cover its part of the Medicaid expansion for an estimated 90,000 Nebraska residents could come with cuts to what everyone receives under Medicaid statewide. Other options to make up the funds—from work requirements that would cut eligibility to tobacco taxes to make up the shortfall—are still on the table.

Maine: Former Maine Governor Paul LePage made fighting Medicaid expansion a centerpiece of his incumbency. After Maine voters passed an expansion initiative in 2017, LePage didn’t bother crafting a repeal bill: He just refused to implement the legislation—which would have covered 70,000 additional low-income residents. In November, however, he was voted out of office, and a state judge gave the governor a deadline of December 5 to “make meaningful progress on setting up the health care expansion,” according to Think Progress. Instead, he requested new work requirements for Medicaid recipients, which were approved by the Trump administration on December 21.

Maine’s new governor, Janet Mills, has put an end to the struggle, at least temporarily. In her first days in office, she rejected the work requirements, and said that her administration will double down on job training programs for Medicaid recipients, instead.

Reevaluating redistricting

Michigan: Michigan voters approved an initiative to create an independent redistricting commission to draw new legislative boundaries in 2021. That’s still in the works, but the state has another districting fight to finish first. Michigan Secretary of State Jocelyn Benson, the newly elected Democrat, announced a proposal to settle a redistricting lawsuit by redrawing at least 11 state house districts before the 2020 election.

Last week, Republican state lawmakers moved to delay the federal gerrymandering trial, but the U.S. Supreme Court shot down the request. The lawsuit, which argues that the last round of redistricting maps in Michigan (drawn in 2011) gave the GOP a disproportionate advantage. Benson, who will serve as a state defendant in the case, said she will not call witnesses or submit evidence to challenge the claim of gerrymandering. The state could look at changes to its maps ahead of the 2020 election before they are automatically redrawn in 2021.

Colorado: Colorado’s plan to create an independent redistricting commission (four Republicans, four Democrats, and four independents) sailed past voters in the last election and hasn’t run into any challenges since.

Missouri: Former Missouri State Senator Bob Johnson said that Missouri voters want to see “compact, contiguous, and competitive” legislative districts—“squares and rectangles and that kind of thing.” Missouri voters agreed: More than 62 percent of them approved Amendment One, a reform package that bans gerrymandering, among other provisions. Yet other Republicans in Missouri, including Governor Mike Parson, have singled out the redistricting plan for criticism. The ballot measure makes it the responsibility of the state demographer to draw the legislative maps (which would be approved by an independent commission). Missouri lawmakers have already voted to overturn a component of the “Clean Missouri” initiative that would open state legislator’s records to the public. “Voter-approved constitutional amendments aren’t suggestions; they are the law,” reads an editorial in the St. Louis Post-Dispatch, a message that could be renewed if Parson and other conservatives take action to dial back the gerrymandering ban.

Utah: After lawmakers in Utah found the two-thirds majority they needed to override Medicaid expansion, they may turn their attention to Proposition 4, which creates an independent redistricting commission. That one is likely to face legal challenges from Republican state senators who say that an independent commission is unconstitutional. So far, lawmakers haven’t introduced any legislation to address the ballot initiative itself.

Medical cannabis

Utah: Even before 53 percent of Utah voters passed a citizen-initiated medical marijuana legalization measure last November, Republicans in the state, with the support of local Mormon leaders, vowed to draft a repeal bill. True to their word, a new, scaled-down measure was introduced at the end of November and a special session was called to vote on it. By December, Proposition 2 was replaced with the Utah Medical Cannabis Act, which reduces the number of illnesses eligible for a cannabis card and tightens tracking requirements. It’s a compromise meant to both prevent a full gutting of the bill and “prevent the diversion of product into a black market,” said Speaker Greg Hughes.

Still, advocates fear the amended legislation will keep medical cannabis out of the hands of patients who need it, and voters argue that the alternate bill is unconstitutional on its face. Last week, a case filed by state voters—without the support of any attorneys—was approved to be heard by Utah’s Supreme Court in March. They accuse the governor, lieutenant governor, and legislature of “eviscerat[ing] the fundamentally-protected right of the people to initiative effective legislation,” according to the Salt Lake Tribune.

Minimum wage hikes hold tight

Minimum wage expansions have proven less sticky. Arkansas and Missouri, which both approved wage hikes in November, are just two of 20 states that rang in the new year with higher minimums, as jurisdictions that approved minimum wages in earlier elections continue the process of incrementally increasing their rates. Arkansas’ hourly wages will start at a $9.25 floor in 2019, and will reach $11 an hour by 2021, while Missouri’s will start at $8.60 an hour and increase 85 cents a year to reach $12 in 2023.

Although Governor Asa Hutchinson, a Republican, called Arkansas’ raise a “job-killer,” 68 percent of voters disagreed, and it looks like Hutchinson will not defy them. “People call Arkansas conservative, but it’s more populist,” Jeremy Horpedahl, an assistant professor of economics at the University of Central Arkansas, told the Washington Post.

In Washington, D.C., the minimum wage is rising—by July of this year, the city will have the highest minimum wage, at $13.25 an hour, which will reach $15 by 2020. But its tipped workers won’t get the minimum wage increase that 55 percent of city voters approved via Initiative 77 last year: After a months-long back and forth over legislation that would have raised the tipped workers’ floor from $3.89 to meet the city-wide minimum of $15 by 2026, city council members voted 8-5 to repeal it in October. Efforts to revive Initiative 77, with yet another ballot measure, have thus far been unsuccessful.

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