No one would say it was a good night for the prospects of Medicaid expansion. But I would argue the landscape didn’t really change all that much.
One clear loss for the issue was Governor LePage’s victory in Maine –a state where he has repeatedly vetoed the expansion. And Arkansas results – especially in the state legislature that must approve the expansion every year with a 75% margin — threaten the future of the “private option” there.
On the flip side of the Maine outcome is Alaska where Independent Bill Walker is holding a slim lead and is supportive of expansion. His election could make the difference there.
The other closely watched gubernatorial races on this front – Wisconsin and Florida – register in the no change column. Wisconsin has its own version of Medicaid expansion that I have blogged about before. It has proven to be fiscally irresponsible but at least provides a path to coverage.
And, as I blogged about yesterday before the elections results were in, the governor’s race was not the definitive variable for Medicaid in Florida – rather the expiration of the state’s special hospital funding it receives through a Section 1115 waiver next year will drive the discussion.
In states where the discussion is live – Indiana, Utah, and other Mountain West states (Wyoming, Montana) the election has very little relevance.
Ultimately I think the election only accentuated what has been true for some time. The fate of the Medicaid expansion lies in Republican hands – state legislators and Governors in the remaining 23 states that have not moved forward. So this is a fight within the Republican Party.
As Governor Kasich of Ohio said a few weeks ago, those opposed to closing the coverage gap by expanding Medicaid are doing so for ideological reasons. Pundits are opining that the Republicans won big last night because they kept the extreme elements of their party under wraps. What the election has put into sharp relief for the Republicans is that they now must come together as a party and govern.
So next year, when Arkansas legislators must vote yet again to sustain the private option, the divisions within the Republican party will be on full view. Because Arkansas uniquely requires an annual vote of 75% to keep the expansion going, a minority of Republicans could choose to end it. In doing so, they would eliminate a major success story – the state has had one of the sharpest drops in its uninsurance rate in the country. And 200,000 Arkansans would lose their health coverage in a state with just under 3 million residents. Is that what the Republicans want to do going into 2016?
