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Thursday, October 9, 2014

Health Care for Millions of Americans Hinges on the Gubernatorial Races

Patrick Willard

Senior Director of State and National Strategic Partnerships

For millions of uninsured Americans, the midterm gubernatorial races in more than a dozen states will determine whether they can get access to affordable health care through Medicaid expansion. 

Of the 23 states that have not expanded Medicaid, 15 have gubernatorial races in November—setting the stage for potential Medicaid expansion in 2015. (See our infographic for a map and digest of the political landscape.)

While much of the focus of the midterm elections has been on the partisan control of the Senate, some of the governors races could play a large role in reducing the number of uninsured Americans and extending the reach of the Affordable Care Act. 

In this post, we discuss the 5 states to watch this November.

The top 5 states where the outcome of the governor’s race will likely have a direct impact on the prospects of Medicaid expansion

  • Maine—Gov. Paul LePage (R) twice vetoed legislation expanding Medicaid and is trailing in polls to his Democratic opponent in a three-way race. LePage won four years ago with 38 percent of the vote in a similar three-way contest.
  • Wisconsin—Gov. Scott Walker (R) chose to extend state-funded health care instead of expanding Medicaid. Walker is in a close race for re-election. And on the same ballot in 20 local jurisdictions, voters will be able to vote directly on the question of whether to expand Medicaid through a local advisory referendum.
  • Kansas—Gov. Sam Brownback (R) is losing moderate GOP endorsements in his race for re-election. He has already turned down federal dollars to expand Medicaid. He faces Paul Davis (D) in a race that is considered a toss-up by pollsters. Davis believes the increased federal funds under expansion will help the state’s health industry and economy. 
  • Florida—the Sunshine State’s former Gov. Charlie Crist (D) is challenging Gov. Rick Scott (R). Crist is making his support for full Medicaid expansion a focus of his campaign. Still, any expansion proposal would face a tough atmosphere in the legislature, where Scott’s support failed to win approval in the House.
  • Georgia—State Sen. Jason Carter (D) is challenging Gov. Nathan Deal (R). Carter is criticizing Deal’s decision to turn down federal funds for extending Medicaid to Georgia residents. Any effort to expand Medicaid, however, will have to clear a conservative state legislature first.

Even states with Medicaid expansion may face challenges if new governors don’t support the expansion

In those states that have expanded Medicaid, the program could face challenges with a new state executive. 

When states expand Medicaid, health care advocates still have a lot of work to do; they often have to gear up for annual campaigns to make sure the legislature reauthorizes Medicaid expansion. Newly elected governors who were not proponents of the expansion may flex their legislative muscle to make reauthorization an uphill battle for Medicaid expansion’s supporters.

Arkansas and Arizona both expanded Medicaid because of the powerful advocacy of their governors. But Arkansas Gov. Mike Beebe (D) and Arizona Gov. Jan Brewer (R) are not on the ballot this year, and the outcome of the races in those states could result in a tough reauthorization fight for Medicaid advocates. 

The governor’s race is considered a toss-up in both states. 

Republicans find Medicaid to be a winning issue 

Some Republican governors who embraced their state’s Medicaid expansion are highlighting it in their races. 

Gov. Rick Snyder of Michigan is touting his support for Medicaid expansion in a close race against Mark Schauer, a former Democratic Congressman. The Associated Press quoted Snyder at a campaign event:

"We have lower-income but hard-working people getting health care that didn't before. … What a difference in people's lives that's making."

Elsewhere, GOP executives who expanded Medicaid are cruising to re-election with large leads heading into November. Gov. Brian Sandoval of Nevada and Gov. Susana Martinez of New Mexico embraced expansion early. 

Lame duck governors may feel less pressure to resist Medicaid expansion

Finally, in some states that did not expand, governors are running for their final term in office. If they are progressive, they may feel less political pressure to resist a Medicaid expansion in their state. And, if they are conservative, they might be more willing to go after the federal dollars that expansion brings. In 11 gubernatorial races in particular, the incumbent will be term-limited if re-elected. Two of those governors—Bill Haslam in Tennessee and Matt Mead in Wyoming—are currently in talks with federal officials about the flexibility of Medicaid waivers for an expansion. 

Whether it is on the ballot or not, states will be grappling with Medicaid expansion in 2015.