Medicaid caught two big waves in Tuesday’s elections after some politically stormy years.

First: It appears safe from any further attempts to whittle it down from congressional Republicans. Democrats will now control the House and can halt any future efforts to replace the Affordable Care Act. In their repeal-and-replace bills last year, GOP members had proposed sizable reductions for future Medicaid spending.

Second: The program will be expanded next year in three GOP-led states – and possibly two more – that up until now had declined to extend Medicaid coverage to Americans earning up to 138 percent of the federal poverty level, as envisioned under the ACA.

Voters in Idaho, Utah and Nebraska approved ballot initiatives for Medicaid expansion, making a combined 363,000 more people eligible for the program next year. And Democrats won gubernatorial races in Wisconsin and Kansas, two other Republican-led states that had resisted expansion but now may be more open to it.

We should mention another state, too. In Maine, the very first state to approve Medicaid expansion via a ballot question in 2017, Gov.-elect Janet Mills, a Democrat, says carrying it out will be a top priority. Her predecessor, Paul LePage, a Republican, had held up expansion in court, saying it would cost the state too much money.

“Citizen power propelled the biggest expansion of Medicaid in heavily Republican states since the early years of the Affordable Care Act, with hundreds of thousands of poor and vulnerable residents standing to gain health coverage as a result of Tuesday’s elections,” The Washington Post reported.

Let’s add it all up. With the addition of Idaho, Utah and Nebraska, 36 states and the District are on board with expanded Medicaid. That number could very well climb to 38 states if Kansas and Wisconsin eventually follow suit. All told, about half a million more people could join the massive federal-state health insurance program for the low-income and disabled that covers more than 1 in 5 Americans.

To Democrats and supporters of the ACA, that’s a huge victory, given the central role Medicaid has played in the Obamacare wars.

Vox’s Sarah Kliff tweeted Tuesday: “”Hard to overstate how strongly Medicaid won last night, mostly in red states.”

Jesse Lehrich, communications director of Organizing for Action, tweeted Tuesday: “Idaho, Utah, & Nebraska all expanded Medicaid tonight.300,000 people gain access to health care.”

Many Republican governors spurned the extra federal expansion dollars provided under the ACA, citing opposition to the health-care law and arguing it would still cost their states too much money. But it appears – at least in the ballot initiative states – that voters didn’t quite agree with their political leaders.

“This election proves that politicians who fought to repeal the Affordable Care Act got it wrong,” Jonathan Schleifer, executive director of the nonprofit Fairness Project, a group that worked to get the initiatives passed, told reporters Wednesday. “Expanding access to health care isn’t a blue-state value or a red-state value; it’s an American value.”

Republicans ran straight into that reality when they tried to repeal and replace Obamacare last year, struggling to gin up public support for their House and Senate health-care bills, which would have pared back Medicaid spending. While Republicans like to envision a society in which people don’t need to rely on the government for help, it’s hard to sell that idea to people who stand to lose such benefits.

Now that even more states are jumping onto the Medicaid expansion bandwagon, the ACA will be even more entrenched – further darkening Republicans’ chances of ever repealing it. Just 14 states, primarily in the South and Midwest, are holdouts. An estimated 2.2 million people in those states are missing out on Medicaid coverage as a result, according to estimates by the Kaiser Family Foundation.

The next step for Idaho, Nebraska and Utah is to submit a state plan amendment to the Centers for Medicare and Medicaid Services. Once CMS approves these SPAs, typically within a few weeks or months, states can move forward with expanding enrollment.

Utah officials are aiming to have the expansion program ready by April 1, the deadline laid out in the ballot initiative itself. It’s a big job, considering the state is projected to increase its total Medicaid enrollment by 50 percent. But Utah Medicaid Director Nathan Checketts told me his staff started setting the wheels in motion even before Tuesday’s election, when they saw polling on the initiative.

“We saw the polling numbers were high, that it looked like it would pass,” Checketts said. “So we’ve been working behind the scenes to be considering what types of system changes might be necessary. We think we can hit those targets, but there is a lot of lead time.”

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