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Report: How gerrymandering has limited Medicaid coverage

The debate over gerrymandering often focuses on what partisan mapmaking means for election outcomes. But that's just the means to a policy-making end. A liberal think tank has just released its second report demonstrating how gerrymandering impacts legislative decisions, this time focusing on Medicaid.

A study released Monday by the Center for American Progress details the impacts gerrymandering has had on how states determine Medicaid eligibility. CAP found that despite significant bipartisan support for Medicaid nationwide, states with Republican-controlled legislatures were more likely to limit access to the government-subsidized health insurance.

CAP is part of a growing movement advocating for a change in the way congressional and state legislative district maps have traditionally been drawn. Rather than have state lawmakers decide, redistricting reform groups say, independent commissions should have the mapmaking authority.

"A fair process for drawing districts is fundamental to democracy, helping to ensure that voters' voices are heard on critical issues such as access to health care," the report states.


Medicaid provides health insurance coverage to approximately 65 million low-income Americans, with costs jointly covered by the federal and state governments. And it is popular among Americans regardless of political party: Nearly three-quarters of Americans have a favorable view of Medicaid, including 82 percent of Democrats and 65 percent of Republicans.

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But because states — many with partisan gerrymanders — have the latitude to determine eligibility, millions of Americans have been hindered from accessing Medicaid, CAP reports. And yet, even in the 14 states that have yet to expand Medicaid since the Affordable Care Act coverage provisions were changed six years ago, at least 71 percent of residents support the program, according to a poll by the Kaiser Family Foundation.

CAP analyzed how Medicaid coverage was affected by gerrymandering in four red states: Georgia, North Carolina, Wisconsin and Michigan. The first three are among the 14 that have not expanded coverage. Conservatives in those legislatures have been largely opposed to Medicaid expansion, and partisan gerrymandering has given more seats to the GOP than what would have been allotted through a fair redistricting process, CAP reports.

For instance, in North Carolina, Democrats received a narrow majority of votes cast in the 2018 election, but Republican candidates won more seats. "Had Democrats received a share of the seats commensurate with their share of the votes — that is, a majority — they almost certainly would have expanded Medicaid," CAP argues in its report.

While Michigan was the sole state in the report to expand Medicaid, the Republican-controlled Legislature also opted to impose work requirements, meaning certain employment activities would need to be verified in order to receive coverage. Wisconsin's implementation of work requirements has been delayed until April. Georgia Gov. Brian Kemp favors adding such provisions in his state as well.

"Gerrymandering in these states has allowed conservative politicians to cater to the extreme right wing and oppose policies that would save thousands of lives at minimal cost to state taxpayers," said Alex Tausanovitch, CAP's director of campaign finance and electoral reform and co-author of the report.

Gerrymandering impacts every issue of public concern, Tausanovitch said. This report is the second by CAP detailing the effects of partisan mapmaking; the first analyzed state gun control laws.

The most promising solution to combat partisan gerrymanders is state-sanctioned independent redistricting commissions. Fourteen states have already given such commissions the authority to draw state legislative districts starting in 2021. Eight of them will also use commissions to draw new congressional maps.

North Carolina's districts were redrawn last fall after a panel of judges ruled the old map violated the state Constitution's "fair elections" clause. In 2018, Michigan voters approved the implementation of a 13-member nonpartisan redistricting commission, which will be established later this year. And while support for redistricting reform is growing in Wisconsin, advocates in Georgia face more of an uphill battle.

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