The big ballot measure in Tuesday's elections is in Maine, wherevoters will decide whether, as Jeffrey Young reports, to become the32nd state (plus the District of Columbia) to adopt expanded Medicaid under the Affordable CareAct.

Yes, this is big news. The history so far of Medicaid expansionis that it's a one-way street: States that go for it don't exit,even when anti-Obamacare Republicans are elected vowing to doexactly that. As Sarah Kliff observes, if this issuccessful, expect similar measures in those states that havevoter-initiated ballot measures but haven't expanded Medicaid sofar. At the same time, Democrats will probably pick off a fewgovernor seats and state legislature chambers in the 2018 midterms, perhaps allowing them to acceptthe Medicaid expansion in a handful of states.

Certainly that's good news for Affordable Care Act supporters,especially coming out of the defeat of the Republican repeal effort in Congress thisyear.

At the same time, Kimberly Leonard reports that theDonald Trump administration may be planning an executive order toundermine the Obamacare individual mandate. There's also talk thatthe House may add a repeal of that mandate to their tax bill -- itwould save the government money because fewer people would buyinsurance through the marketplaces. The problem, however, is thatrepealing the mandate may well be a deal breaker for Republicansenators such as Lisa Murkowski and Susan Collins. SinceRepublicans can only afford to lose two senators on the tax bill,and others have said they'll oppose it because of its increases inthe deficit, it's likely that at best this would be a gimmick toget the bill through the House, dump it on the Senate, and let themeither figure it out or take the blame. And, yes, I for one amsurprised that it appears the House may be shifting intoblame-ducking mode on the tax bill, just as they did on thehealth bill.

Back to the individual mandate: It's certainly possible that theTrump administration could go through with an executive order toeliminate it. It still makes no sense, however. Blowing up theindividual market in health insurance in order to blame it on theprevious administration just seems like very foolish politics,since most swing voters will blame the incumbent party for thingsthat go wrong, correctly or not. Whether the logic of the situationwill constrain the president and his administration is, as usual,unknown.

I still do think we're eventually on the way to health carepolitics as usual, in which the parties differ on spending andpolicy around the edges but accept the basic status quo. But we'resure getting there slowly, if it is where things areheaded.

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