How Will the Midterm Election Results Affect Medicaid Expansion?

Although the question of Medicaid expansion is resolved in most states, there are a few where the outcome of the gubernatorial elections—and any changes in the composition of the legislature—may extend Medicaid to people currently in the coverage gap, uninsured adults with incomes below the federal poverty level (FPL). It is also possible that the Arkansas “private option” waiver could be in danger, and it would not be replaced by expansion of traditional Medicaid. In Maine, Florida, and Wisconsin, the replacement of a Republican governor with a Democrat may make the difference.

Maine’s Three-Way Contest

Republican Governor Herbert LePage was running for reelection. He has vetoed Medicaid expansion legislation five times. Both Independent Eliot Cutler and Democrat Mike Michaud are running against him, and both support Medicaid expansion.

Maine has a tradition of electing independent candidates. Independent Angus King served as governor from 1995 until 2003. In 2012, he won the U.S. Senate seat formerly held by Olympia Snowe, who retired. In a previous race between Cutler, LePage, and a Democrat in 2010, Cutler came in second, 10,000 votes behind LePage, and the Democrat, third. This year, polls showed Cutler’s candidacy losing support, however.

As of October  28, 2014, polls showed that Michaud and LePage were tied at 40 percent each, with Cutler at 13 percent. Senator King, who had previously endorsed Cutler, switched his support to Michaud. Cutler began to run what he called a “closing ad” on television. He told voters to “vote their conscience,”  and that if they believe he cannot win, they should vote for one of the other candidates. He has refused to withdraw, however, so any votes for Cutler among the 75,000 absentee ballots that already have been cast had to be counted.   As of Wednesday morning, November 5, 2014, with 86 percent of precincts reporting, LePage had 48.35 percent, Michaud had 43.31 percent, and Cutler, 8.34 percent.  Michaud has conceded. Thus, no change is likely.

Wisconsin’s Race

The incumbent, Governor Scott Walker (R), was challenged by Democrat Mary Burke, who supported Medicaid expansion. Walked has opposed it.  In the most recent poll, Walker and Burke were only one percentage point apart, within the 3 percent margin of error. The Republican-controlled legislature has never passed Medicaid expansion as provided in the Patient Protection and Affordable Care Act (P.L. 111-148), however. And because the state Medicaid program operates under a waiver that covers adults with incomes up to 100 percent of FPL, people with incomes too low for coverage through a health insurance exchange are not left out. Adopting the full ACA Medicaid expansion would require a change in the composition of the legislature. Walker having won reelection, no change is expected in Wisconsin.

Florida

Like Wisconsin, the Florida legislature has not passed Medicaid expansion. Governor Rick Scott (R) initially opposed it. During the   legislative session, however, he changed his mind and tried to persuade the legislature to pass it. He did not make expansion a high priority, dropping it to concentrate on other issues. Now, his opponent, Charlie Crist (D, but formerly Republican governor), strongly favors expansion. Crist even says he would consider using an executive order to achieve it. Scott has not said much about Medicaid during the campaign, and some sources now describe him as opposing it. Unless the legislative opposition weakens, a Medicaid expansion bill would not pass. Rick Scott won reelection, however, and the composition of the legislature is not expected to changes significantly.

Kansas: Brownback Reelected

Governor Sam Brownback (R) and the Republican-controlled legislature refused even to consider expanding Medicaid, although the proposals were supported by hospitals as well as Democrats. Brownback, too, was up for reelection, and his opponent, Paul Davis (D) supported Medicaid expansion. According to Real Clear Politics, the election was a toss-up. Some recent polls showed Davis ahead, while others showed Brownback leading.  Brownback won, however, with 49 percent of the vote. There also is a possibility for movement in the legislature. The Kansas Health Institute reports that several seats in the legislature are up for grabs, so that it is possible that the Democrats could gain a few more seats. There have been several important votes on which moderate Republicans voted with the Democrats. Some observers believe that ten key races, which are close, will set the balance of power in the Kansas legislature.

Arkansas Private Option Endangered?

Arkansas’ private option waiver, which squeaked through the legislature in both 2013 and 2014, is in the hands of the voters, especially those in a few key Arkansas House districts. In 2014, the reauthorization passed the Senate without a vote to spare. The Arkansas Times reports that in two close races, Democratic incumbents are opposed by candidates with strong Tea Party support. If they lose, it will likely be impossible to find the 75 percent supermajority needed for reauthorization. Results were not yet available as of  the morning of November 5.