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Thursday, October 22, 2015

What Three State Elections Could Mean for Medicaid Expansion

Patrick Willard

Senior Director of State and National Strategic Partnerships

Updated October 26, 2015

The 2016 presidential primaries are roiling the political chatter, but a trio of states will be holding elections this fall that may determine the outlook for Medicaid expansion in the year ahead. One election involves a new governor who may expand coverage, another threatens one of the nation’s most successful expansions, and a third involves the control of a state senate that could tip the balance on the issue.

The off-year elections in Louisiana, Kentucky, and Virginia aren’t dominating the Twitterverse like the presidential primary debates. But the outcomes will determine the momentum of the ACA in the region that has been most resistant to expansion.

New governor in Louisiana improves prospects for Medicaid expansion

In October, Louisiana voters set up a governor’s race clash between a proponent of Medicaid expansion and an anti-ACA lawmaker who says he would be open to expansion.

Democrat John Bel Edwards will face GOP U.S. Sen. David Vitter in the November 21 runoff. Edwards pledges to expand Medicaid if elected, while Vitter believes any expansion should be part of a waiver plan that may include work requirements and private insurance plans. Edwards drew 40 percent of the votes in the primary and Vitter picked up 23 percent to enter the runoff race. However, statewide Democrats have been unsuccessful in recent years, including U.S. Sen. Mary Landrieu’s re-election loss in 2014.

Medicaid expansion efforts are being endorsed by chambers of commerce and other business groups promoting a legislative agenda for the next governor. Blueprint Louisiana, a nonpartisan group of community and business leaders, included expansion as one of its four priorities for the next legislative session.

The state legislature in Louisiana also gave the next governor an invitation to take up an expansion. Earlier this year, it passed a resolution with overwhelming support that would allow the incoming governor to use funds raised through a hospital assessment to cover the costs of an expansion. The initiative faces an April 2016 deadline for adoption, thus requiring a quick and heavy lift for whoever assumes the governor’s post. 

Kentucky’s Medicaid expansion in danger 

While Louisiana faces the question of whether to expand Medicaid, Bluegrass State voters are weighing the opposite choice. Like Jindal, Gov. Steve Beshear is term-limited, but there the comparison ends. Beshear has been an outspoken champion for the ACA and Medicaid expansion since he used an executive order to expand coverage in 2013. He touts the success of the expansion effort for making Kentucky the state with the biggest decline in the share of residents without health insurance over the past year.

Democrat Jack Conway, the state attorney general, and Republican Matt Bevin are slugging it out in a toss-up race to succeed Beshear. Bevin, who challenged U.S. Sen. Mitch McConnell in the 2014 GOP primary, has said he wants to scrap the state’s health insurance marketplace, called Kynect, and limit enrollees in the Medicaid program

The election results will determine fate of the expansion in Kentucky and may give opponents momentum in efforts to repeal expansion in neighboring West Virginia where Republican lawmakers took control in the last election.

Virginia elections could tilt the scale in favor of expansion

Virginia Gov. Terry McAuliffe hopes the 2015 legislative races in the Old Dominion will give him the leverage he needs to make expansion possible. Republicans control the state Senate by a 21-19 margin. That balance has thwarted McAuliffe’s efforts to move Medicaid expansion. If Democrats can pick up one additional seat they would gain control of the Senate, where the lieutenant governor casts the deciding vote on ties.

The governor is pinning his hopes on a handful of districts to pick up Senate seats. Should Democrats take control, McAuliffe is expected to use budget negotiations to wring concessions out of Republican House leaders. 

The 2015 outcomes will undoubtedly play into legislative sessions in 2016 and the elections on the state levels in the presidential election year. Not only will the top of the ticket be influenced in 2016, but also the dozen governors’ seats that will be on the ballot.