“There are business folks who have advocated for the Medicaid expansion because they think it makes financial sense. There's an argument that the federal match is a good deal,” he said.
But Henson added that, if Abbott wins, he doubted Medicaid expansion would occur. “I think there's still a pretty strong wellspring of fear in the Republican Party that anybody who votes for Medicaid expansion will then have to face opponents accusing them of supporting Obamacare,” he said.
Illinois expanded Medicaid in July 2013, one of the first states to do so, and has signed up more than 300,000 people so far, said Linda Baker, a professor at Southern Illinois University.
Current Democratic Gov. Pat Quinn created a state-based healthcare insurance exchange called Get Covered Illinois in October 2013. Quinn's opponent for governor, Republican businessman Bruce Rauner, has not taken a strong stance against Medicaid expansion thus far.
Two strongly Republican-controlled states, Georgia and Florida, are not likely to see big changes in healthcare exchange offerings or Medicaid expansion after their elections this fall.
In Georgia, incumbent Republican Gov. Nathan Deal has declined federal funding to expand Medicaid, while Democratic opponent Jason Carter, Jimmy Carter's grandson, has supported such expansion. But Carter is not favored to win the race.
However, if Deal wins, he could change his position on Medicaid because he would have reached his two-term limit and wouldn't be worried about another reelection campaign, said Steve Anthony, lecturer in the political science department at Georgia State University. “It wouldn't surprise me if he softened up on some of these provisions since he wouldn't face reelection again,” he said.
As for a Georgia state-based healthcare exchange, Anthony said Democrats may debate it, but he doesn't see support for it from a Republican governor.
In Florida, where incumbent Republican Gov. Rick Scott is running against former Republican-turned-Democrat Charlie Crist, “From a healthcare perspective, it doesn't really matter who gets elected. At the end of the day, Florida is a weak governor model. All the power really rests in the hands of the legislature,” said Bob Jarvis, a professor of law at Nova Southeastern University.
“The legislature is in the firm control of Republicans and the legislature has no interest in providing healthcare to the poor, or expanding any sort of healthcare,” he said.
Rebecca Kern is a Washington, D.C.-based freelance journalist.