ACA big is­sue on voter agen­das

Obama’s health in­sur­ance over­haul a midterms win­ner

Daily Press - - Business - By Ge­off Mul­vi­hill and Ri­cardo Alonso-Zal­divar As­so­ci­ated Press

WASH­ING­TON — The per­son­al­ity loom­ing over the 2018 midterms was Pres­i­dent Donald Trump. The is­sue was health care, the top con­cern for vot­ers as they de­cided how to cast their bal­lots.

This month's elec­tion showed a na­tion in­creas­ingly — if be­lat­edly — in step with for­mer Pres­i­dent Barack Obama's ap­proach to it.

Health care was the top is­sue for about one-fourth of vot­ers, ahead of im­mi­gra­tion and jobs and the econ­omy, ac­cord­ing to VoteCast, a na­tion­wide sur­vey of more than 115,000 vot­ers and about 22,000 non­vot­ers con­ducted for The As­so­ci­ated Press by NORC at the Univer­sity of Chicago.

Those most con­cerned with health care sup­ported Demo­cratic can­di­dates over­whelm­ingly, help­ing the party claim the House.

While Repub­li­cans' hold on the Se­nate grew, putting Democrats in con­trol of the lower cham­ber makes it even less likely that Trump will be able to undo Obama's over­haul, which cre­ated sub­si­dized cov­er­age for some lower-in­come peo­ple, al­lowed states to ex­pand Med­ic­aid cov­er­age for oth­ers with the fed­eral govern­ment pick­ing up most of the cost, and barred in­sur­ers from dis­crim­i­nat­ing against peo­ple with pre-ex­ist­ing med­i­cal con­di­tions.

The law was one of Obama's key leg­isla­tive ac­com­plish­ments, but it proved un­pop­u­lar af­ter Democrats passed it with­out a sin­gle Re­pub­li­can vote.

A back­lash pro­pelled the GOP to take con­trol of the House in 2010 and the Se­nate in 2014, sig­nif­i­cantly nar­row­ing what Obama could ac­com­plish.

But by last year, “Oba­macare” was pop­u­lar enough that a GOP-con­trolled Se­nate blocked an ef­fort to scrap the over­haul.

That vote was a fac­tor in the only Se­nate race where a Re­pub­li­can in­cum­bent lost a re-elec­tion bid.

In Ne­vada, where the ma­jor­ity of vot­ers said they dis­ap­proved of Trump's han­dling of health care, Demo­cratic chal­lenger Jacky Rosen at­tacked in­cum­bent Re­pub­li­can Sen. Dean Heller for sup­port­ing Trump's ef­fort to re­peal the health care law.

“In time, changes will be made,” Mike Leav­itt, health sec­re­tary un­der Pres­i­dent Ge­orge W. Bush, told the AP. “But re­peal­ing the statute is now not pos­si­ble, even in the mind of the most ar­dent op­po­nent.”

The health care im­pact of the elec­tion goes beyond Congress. Vot­ers in the Re­pub­li­can-dom­i­nated states of Idaho, Ne­braska and Utah all passed bal­lot mea­sures to ex­pand Med­ic­aid, which could bring cov­er­age for an ad­di­tional 363,000 low-in­come adults, adding to the 12 mil­lion al­ready cov­ered by the ex­pan­sion else­where.

Un­der the Af­ford­able Care Act, fed­eral tax­pay­ers pick up most of the bill for ex­pan­sion. Start­ing in 2020, states will have to con­trib­ute 10 per­cent of the cost.

“For all the peo­ple who have been slip­ping through the cracks in our health care sys­tem in Utah, there is fi­nally good news,” RyLee Cur­tis, cam­paign man­ager for Utah De­cides Health­care, said Wed­nes­day. “Help is on the way.”

Ad­vo­cates, how­ever, were dis­ap­pointed by the out­come in Mon­tana, where vot­ers re­jected a mea­sure that would have made that state's Med­ic­aid ex­pan­sion per­ma­nent with fi­nanc­ing from a to­bacco tax. The de­bate isn't over, but it will move to the state leg­is­la­ture in­stead.

Jonathan Sch­leifer, ex­ec­u­tive direc­tor of The Fair­ness Project, which cam­paigned for the ex­pan­sion mea­sures, said states in­clud­ing Mis­souri, Flor­ida and Ok­la­homa could be pur­sued for fu­ture bal­lot mea­sures.

Democrats picked up gov­er­nor­ships Tues­day in two states that may now ex­pand Med­ic­aid — Kansas and Wis­con­sin.

In Kansas, health care tied with im­mi­gra­tion as vot­ers' top is­sue. In Wis­con­sin, which did not join the fed­eral Med­ic­aid ex­pan­sion but does al­low more adults into the pro­gram al­ready, it was the big­gest con­cern iden­ti­fied by about onethird of vot­ers.

In both states, 7 in 10 of vot­ers who said health care was their main con­cern voted for the Demo­crat for gover­nor. That helped put Tony Evers over the top in his race against in­cum­bent Re­pub­li­can Scott Walker in Wis­con­sin and pushed Laura Kelly to vic­tory in a close race against Re­pub­li­can Kris Kobach in Kansas.

Kelly got big cheers in her vic­tory speech when she called for a Med­ic­aid ex­pan­sion, which she said was im­por­tant “so that more Kansans have ac­cess to af­ford­able health care, our ru­ral hospi­tals will stay open and the tax dol­lars we've been send­ing to Wash­ing­ton will come back home.”

Med­ic­aid was also a key is­sue in Maine, where vot­ers last year ap­proved a bal­lot mea­sure to ex­pand but where the cur­rent gover­nor, Re­pub­li­can Paul LePage, re­fused to im­ple­ment it. Demo­crat Janet Mills cam­paigned on im­ple­ment­ing it and de­feated Re­pub­li­can Shawn Moody, who cam­paigned against ex­pan­sion.

Tues­day's elec­tion results were far less clear on where Amer­i­cans stand on a move to uni­ver­sal health cov­er­age, an idea that a grow­ing num­ber of Demo­cratic can­di­dates, in­clud­ing sev­eral con­sid­er­ing pres­i­den­tial bids, have been back­ing.

In his cam­paign for gover­nor in Flor­ida, Demo­crat Andrew Gil­lum called health care for all a “north star” that the state should aspire to while of­fer­ing up the in­ter­me­di­ate step of ex­pand­ing Med­ic­aid as a must-do in the na­tion's third most pop­u­lous state. The ma­jor­ity of Flor­ida vot­ers in the AP sur­vey dis­ap­proved of Trump's han­dling of health care, and 3 in 5 also said it should be the govern­ment's re­spon­si­bil­ity to pro­vide cov­er­age.

There, health care was tied with im­mi­gra­tion as vot­ers' top con­cern and Re­pub­li­can Ron DeSan­tis, a for­mer mem­ber of Congress closely aligned with Trump, ap­peared to win a nar­row vic­tory.

That vic­tory may now be in jeop­ardy, how­ever,a s the race may be headed for a state-man­dated re­count.

Kath­leen Se­be­lius, health sec­re­tary un­der Obama, told the AP she ex­pects House Democrats to start de­sign­ing a frame­work for cov­er­ing all Amer­i­cans and for that to be a ma­jor is­sue in 2020 elec­tions.

“One of the things this elec­tion clearly demon­strates is that health care for all is a uni­fy­ing prin­ci­ple for the Democrats,” she said.

RICHARD DREW/AP

Sev­eral health care stocks stretched a post-elec­tion price bump into Thurs­day, as Wall Street re­acted to a di­vided Congress that may not re­peal the Af­ford­able Care Act or pro­duce ma­jor leg­is­la­tion that roils the sec­tor.

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