Healthcare activists in Florida are considering taking a page from Maine, Idaho, Nebraska, and Utah by taking Medicaid expansion directly to the state's voters. If the referendum push succeeds it could be a significant factor in one of the most important of swing states in the 2020 election.
A coalition of local and national healthcare groups has been quietly gathering signatures for a referendum for weeks. At stake is coverage for 700,000 low-income people. Florida has the fifth-highest rate of uninsured residents in the nation, just behind Texas, Oklahoma, Alaska, and Georgia. (Oklahoma's governor is considering expansion, Alaska Republicans are considering repealing the expansion they took in 2015, Texas remains the leader in fighting affordable healthcare on every single front, and Georgia lost out after Stacey Abrams’ gerrymandered loss. Neither Texas nor Georgia allow ballot initiatives.)
Florida activists have one big challenge the smaller-population states didn't: It's really expensive to run statewide campaigns there, and the threshold for referendum votes to win is 60 percent. "What our approach has been on these ballot initiatives is you don’t actually take it to the ballot unless you feel you’re going to win," said Patrick Willard of Families USA, one of the groups involved Florida. "That doesn't mean that you don't start the process—especially in a state as complicated as Florida—and try to meet the signature goals on the front end just to get the things off the ground." In the case of Idaho, the hurdles for just getting on the ballot were significant and months and months of preparation were necessary, so good on the Florida organizers for getting ahead on this.
Unfortunately, as the voters of Maine, Idaho, and Utah now know, voting for Medicaid expansion doesn't necessarily mean you're going to get it. In Maine, former Republican Gov. Paul LePage just flat-out refused to allow its implementation. In Utah, the legislature is working this very week to essentially repeal the expansion voters there approved. In Idaho, Republican legislators are trying to restrict it to as few people as possible.
The bottom line is 2020 is going to have to be an even bigger healthcare year than 2018. The only way for Republicans to get the message is to throw them out. Florida failed to do that in 2018, but has another big chance next time around.