Democrats see health care as winning issue

Associated Press

WASHINGTON — Emboldened by election wins, Democrats are starting to see a political edge in health care, particularly widening Medicaid access for more low-income people.

In Virginia, Democrat Ralph Northam promised a vigorous push as governor to expand Medicaid. Voters who said health care was important went decisively for Mr. Northam, according to political analysts. In Maine, voters defied Rep u b l i c a n Gov. Paul LePage’s determined opposition by passing a referendum to expand Medicaid to cover an estimated 70,000 more residents.

During Barack Obama’s presidency, health care was often seen as a political liability for Democrats. In 2010, they lost their House majority following the bitter battle to pass the Affordable Care Act with no Republican support. In 2014, Democrats gave up the Senate a year after the Obama administration fumbled the rollout of HealthCare.gov. And cand i d a t e D o n a l d T r u m p seized on rising “Obamacare” premiums as part of his closing argument in the 2016 presidential campaign.

But public opinion seems to have shifted amid widespread opposition to Trump-backed “repeal and replace” bills that would have left millions uninsured and made it harder for people with pre-existing health problems to get coverage. The GOP bills not only would have repealed the ACA’s Medicaid expansion, but also would have limited future federal financing for the entire program, even prompting opposition from some Republican governors.

“I think health care is a driving motivator for Democrats to elect people who will not take it away,” Sen. Patty Murray of Washington, ranking Democrat on the Senate Health Committ e e , said Wednesday. “What’s happened in the past six months is that Medicaid went from a hidden thing to something everyone has heard about. Before, nobody said, ‘ I’m on Medicaid.’ Now we know it’s our next-door neighbor.”

Medicaid is a federalstate health program that covers about 75 million Americans, or about one in five. Beneficiaries include elderly nursing home residents, severely disabled people of any age, and many newborns and pregnant women. Under the ACA, it was expanded to cover more low-income adults, who in many cases work jobs that don’t provide health insurance.

Before Maine’s vote, 31 states and Washington, D.C., had expanded Medica i d under ACA. Now Maine-style referendum campaigns are planned in at least three states — Alaska, Idaho and Utah. In Alaska, which has expanded Medicaid, voters will be asked if they want to preserve the expansion even if Washington decides to roll back federal financing.

Medicaid expansion has the support of the hospital industry and the medical community, influential interest groups in just about every state.

“I honestly believe that if you had a referendum on expanding Medicaid in most of the states that don’t have it, it would win,” said Rep. Frank Pallone of New Jersey, the senior Democrat on the House committee that oversees the program. “People know the value of Medicaid in a way that they didn’t before.”

And in Virginia, the network exit poll asked respondents which one of five issues mattered most in deciding their vote for governor: 39 percent said health care, far more than any other issue. And health-care focused voters favored Mr. Northam by a giant 77 percent to 23 percent margin in preliminary exit polls. Republican Ed Gillespie won handily among those who named taxes and immigration as their top issue. The candidates split among those who picked gun policy.

In that state, Chris Hurst, a former news anchor whose journalist girlfriend was fatally shot during a live broadcast in 2015, defeated the Republican incumbent for a state House seat. The Democrat’s campaign was backed by guncontrol groups, but that wasn’t his main campaign issue. Instead, he focused on education, the environment — and health care.

Republican Ohio Gov. John Kasich said Tuesday’s contests are a lesson to Republicans that catering to the party’s conservative base with hard-line appeals and incendiary language turns off the moderate voters they need to win in states like his own. He said his party must choose between a political message of “blaming and scapegoating” or a more hopeful pitch centered on everyday issues like the economy and health care.

“This is a repudiation of the politics of narrow,” Mr. Kasich said. In an apparent reference to Mr. Trump’s 2016 victory, the governor added, “The politics of anger may work for a moment in time, but it does not last, thank goodness.”

Other Republican Party leaders expect their political outlook to improve dramatically once the GOP-led Congress takes action on issues such as health care. “If anything, this just puts more pressure on making sure we follow through,” House Speaker Paul Ryan said at an event hosted by the Washington Examiner. He added, “I think it simply means we’ve got to deliver.”

Public opinion expert Robert Blendon says what’s changing is not so much that Americans have suddenly fallen for “Obamacare,” but that there’s a growing belief that government does have a responsibility to make coverage available and affordable.

“The Obamacare weapon was great for Republicans until you debated what the Republican alternative was,” said Mr. Blendon, who teaches at the Harvard T.H. Chan School of Public Health. “The alternative can’t be dropping people and taking away protection for pre-existing conditions.”

Using Medicaid to cover low-wage workers is popular with the public, he added, at a time when many jobs don’t come with benefits once considered standard. Separately, studies have shown that Medicaid coverage is associated with fewer financial problems and better emotional health.

The Trump administration seems to be moving in a different direction, however.

In an Election Day speech to state Medicaid officials, the top administration official overseeing the program took issue with Medicaid expansion.

“The thought that a program designed for our most vulnerable citizens should be used a vehicle to serve working age, able-bodied adults does not make sense,” Seema Verma, head of the Centers for Medicare and Medicaid Services, said Tuesday.

Ms. Verma said the goal should be to help workingage adults “move up, move on and move out,” underscoring the administration’s willingness to approve state requests for work requirements for Medicaid beneficiaries.

“We shouldn’t just celebrate an increase in the rolls, or more Medicaid cards handed out,” she said.