Med­i­caid ex­pan­sion’s fate may hang on gover­nors’ races

Modern Healthcare - - NEWS - By Vir­gil Dick­son

The out­come of gu­ber­na­to­rial elec­tions in 15 states could have a piv­otal im­pact on health­care for mil­lions of peo­ple in those states, with the fate of Med­i­caid ex­pan­sion and the Oba­macare ex­changes hang­ing in the bal­ance.

Even though gover­nors have no di­rect say on the fed­eral Pa­tient Pro­tec­tion and Af­ford­able Care Act, Repub­li­can gu­ber­na­to­rial can­di­dates have ham­mered away at the law. For their part, Demo­cratic can­di­dates have jabbed their op­po­nents for not ex­pand­ing Med­i­caid to thou­sands of low-in­come adults and for denying their state bil­lions in fed­eral fund­ing.

Med­i­caid ex­pan­sion has been a ma­jor con­flict point in many tele­vised de­bates around the coun­try. Polls show ex­pan­sion is popular even in many red states, and some Democrats have tried to cap­i­tal­ize on that.

Other health­care de­bat­ing points in the gover­nors’ races have cov­ered prob­lems with the staterun in­surance ex­changes, whether pre­mi­ums are go­ing up or down and plan can­cel­la­tions.

What’s hardly been dis­cussed is whether the new gover­nors in states us­ing the fed­eral ex­change will push to es­tab­lish state-run ex­changes and avoid the loss of fed­eral pre­mium sub­si­dies if the U.S. Supreme Court strikes down sub­si­dies through the fed­eral ex­change.

States with close elec­tions where the out­come could lead to Med­i­caid ex­pan­sion in­clude Florida, Ge­or­gia, Kansas, Maine and Wis­con­sin. States where the out­come of the gov­er­nor’s or leg­isla­tive races could lead to re­peal of ex­pan­sion in­clude Ari­zona, Arkansas, Colorado and Ken­tucky.

On Oba­macare, “The big mes­sage has been, ‘Let’s re­place it with some­thing bet­ter,’ ” said John Braben­der, a strate­gist work­ing on the re-elec­tion cam­paign of en­dan­gered Penn­syl­va­nia Repub­li­can Gov. Tom Cor­bett, who re­cently won CMS ap­proval for a con­ser­va­tive Med­i­caid ex­pan­sion model.

Democrats gen­er­ally have shied from di­rectly de­fend­ing the ACA and run­ning ads on health­care is­sues. In Penn­syl­va­nia, Demo­crat Tom Wolf has stressed his support for ex­pand­ing Med­i­caid but hasn’t made the ACA a ma­jor fo­cus of his ads, said Neil Ox­man of the Cam­paign Group, a Philadel­phia- based me­dia firm. Wolf’s cam­paign has fo­cused on Cor­bett’s pub­lic ed­u­ca­tion cuts and his re­fusal to tax the oil in­dus­try for hy­draulic frac­tur­ing, he said.

In Maine, where Demo­crat Mike Michaud is run­ning against GOP Gov. Paul LePage, a tea party stal­wart, and in­de­pen­dent Eliot Cut­ler, Michaud has hit LePage hard for ve­to­ing the ex­pan­sion of Med­i­caid ap­proved by the state Leg­is­la­ture.

How­ever, nei­ther Michaud nor Cut­ler, who both support the ACA, have re­leased ads fo­cus­ing on health­care, said Amy Fried, a po­lit­i­cal sci­ence pro­fes­sor at the Univer­sity of Maine.

“Jobs and the econ­omy have been more of a fo­cus here,” Fried said. Med­i­caid and health­care have come up promi­nently in the de­bates, how­ever.

In Alabama, even though polls show strong support for Med­i­caid ex­pan­sion and a state-run ex­change, Repub­li­can Gov. Robert Bent­ley has a 30-point lead in the polls against Demo­crat chal­lenger Dr. Parker Grif­fith.

“Bent­ley con­tin­ues to con­flate Med­i­caid with be­ing on the ‘wel­fare roll’ and ‘de­pen­dent on gov­ern­ment’,” said Dana Pat­ton, an as­so­ciate pro­fes­sor of po­lit­i­cal sci­ence at the Univer­sity of Alabama. “That kind of rhetoric seems to be ef­fec­tive in Alabama, de­spite the large num­ber of poor peo­ple who would ben­e­fit from re­ceiv­ing Med­i­caid, many of whom work in low-wage jobs.”

In solidly blue states that have ex­panded Med­i­caid and es­tab­lished state-run ex­changes—such as Colorado, Con­necti­cut, Hawaii and Rhode Is­land, where polls show tight gu­ber­na­to­rial races—even if Repub­li­can can­di­dates win, they likely would leave things as they are, said Deb­o­rah Chol­let, a se­nior fel­low at Math­e­mat­ica Pol­icy Re­search.

“At this point, health­care providers and in­sur­ers have come on­board, and there are peo­ple liv­ing ev­ery day with Oba­macare,” she said. “They don’t want to see it go away.”

“At this point, health­care providers and in­sur­ers have come on­board, and there are peo­ple liv­ing ev­ery day with Oba­macare. They don’t want to see it go away.” Deb­o­rah Chol­let Se­nior fel­low at Math­e­mat­ica Pol­icy Re­search

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