Health care opponents swell in wake of midterms
Voters dealt a blow to Obamacare in a number of states this week when they reelected GOP governors who had opposed the law, and even added a few to their ranks, making the climate less hospitable for President Obama’s plans to expand Medicaid.
Democratic challengers fell short in Georgia, Kansas and Maine, effectively killing hopes for Medicaid expansion in those states, while Gov. Scott Walker and Gov. Rick Scott survived tight re-elections in Wisconsin and Florida, respectively, leaving Obamacare supporters doubtful that either state will move to cover more residents.
And with Gov.-elect Asa Hutchinson, a Republican, preparing to take over for a retiring Democrat in Arkansas, that state’s experiment with a “private option” form of Medicaid expansion could be in danger.
Tuesday’s elections shifted the ground on Obamacare, breaking a four-year-long stalemate and putting Republicans on offense when they take control of the Senate next year.
House Speaker John A. Boehner said Thursday they will hold more votes to repeal the entire Affordable Care Act, which are likely to run aground again, but will also pass a number of smaller bills undoing everything from the law’s individual mandate to its tax on medical devices to the independent payment advisory board, which Mr. Boehner termed Obamacare’s “rationing board.”
“There are bipartisan majorities in the House and Senate to take some of these issues out of Obamacare. We need to put them on the president’s desk and let him choose,” Mr. Boehner said.
At the state level, incoming governors who are taking over for Democrats, like Mr. Hutchison, might try their own rollbacks.
Mr. Hutchinson has said Arkansas’s Medicaid program, which leverages federal dollars to buy private insurance for newly eligible residents, is a “pilot project that can be ended if needed.”
But with more than 200,000 Arkansans already enrolled, the new governor may have to find a way to rein in the pioneering plan without scrapping it altogether.
“It remains very difficult to take back a benefit you’ve already given,” said Elizabeth Carpenter, a director at Avalere Health, a Washington-based consultancy.
Obamacare’s framers expected every state to augment the federal-state entitlement, but in 2012 the Supreme Court said states could choose not to expand their programs without forfeiting their existing federal money.
According to the Kaiser Family Foundation, 27 states and the District of Columbia have opted to expand, 21 states have refused, and two are in limbo — Utah is debating the option, and Indiana is waiting on a federal waiver to implement its own version of expansion.
With Medicaid being a key to hitting his target of cutting the number of uninsured, Mr. Obama and his allies took to the campaign trail to try to pressure reluctant states to sign up.
In Maine, Gov. Paul LePage found himself under attack from Democratic challenger Michael H. Michaud, who voted for Obamacare in the House, and who said he’d write a Medicaid expansion bill his first day in the governor’s mansion.
But Mr. LePage, who vetoed five expansion bills in his first term, defeated Mr. Michaud on Tuesday.
In Georgia, meanwhile, Democratic challenger Jason Carter’s platform included expanding Medicaid — but GOP Gov. Nathan Deal rejected that, and his allies ran ads attacking Mr. Carter’s stance. Mr. Deal comfortably won re-election.
“There weren’t quite as many shifts as we thought would be possible,” Ms. Carpenter said.
Some governors have tried to find a middle ground. In Wisconsin, Mr. Walker made sure that people making up to 100 percent of the poverty level would qualify for Medicaid, eliminating the “coverage gap” that hit people in other nonexpansion states.
But he has declined to support expanding Medicaid to cover up to 138 percent of the poverty line, as Mr. Obama wants.
Pennsylvania was a notable exception to the pro-GOP wave.
Democratic governor Tom Wolf will take the reins in Harrisburg just as his Republican predecessor’s Healthy Pennsylvania plan takes root. And he may try to replace departing governor Tom Corbett’s program — a private option-style plan with certain preconditions for enrollees — with a more traditional form of Medicaid expansion several months from now.
As it stands, eligible residents will start to enroll in January, and Mr. Wolf will have to gain support from the legislature for any alternative in line with the Obama administration’s original intent.
“I think the voters would accept either one,” said G. Terry Madonna, a politics professor at Franklin and Marshall College in Lancaster, Pennsylvania, who has polled residents on both Mr. Corbett’s plan and traditional Medicaid expansion.
House Speaker John A. Boehner of Ohio said the Republican-controlled Congress will hold more votes to repeal the Affordable Care Act.
Gov. Rick Scott (top) and Gov. Scott Walker (above) survived tight re-elections in Wisconsin and Florida effectively killing hopes for Medicaid expansion.