Medicaid expansion's fate may hang on governors' races

The outcome of gubernatorial elections in 15 states could have a pivotal impact on healthcare for millions of people in those states, with the fate of Medicaid expansion and the Obamacare exchanges hanging in the balance.

Even though governors have no direct say on the federal Patient Protection and Affordable Care Act, Republican gubernatorial candidates have hammered away at the law. For their part, Democratic candidates have jabbed their opponents for not expanding Medicaid to thousands of low-income adults and for denying their state billions in federal funding.

Medicaid expansion has been a major conflict point in many televised debates around the country. Polls show expansion is popular even in many red states, and some Democrats have tried to capitalize on that.

Other healthcare debating points in the governors' races have covered problems with the state-run insurance ex-changes, whether premiums are going up or down and plan cancellations.

What's hardly been discussed is whether the new governors in states using the federal exchange will push to establish state-run exchanges and avoid the loss of federal premium subsidies if the U.S. Supreme Court strikes down subsidies through the federal exchange.

States with close elections where the outcome could lead to Medicaid expansion include Florida, Georgia, Kansas, Maine and Wisconsin. States where the outcome of the governor's or legislative races could lead to repeal of expansion include Arizona, Arkansas, Colorado and Kentucky.

On Obamacare, “The big message has been, 'Let's replace it with something better,' ” said John Brabender, a strategist working on the re-election campaign of endangered Pennsylvania Republican Gov. Tom Corbett, who recently won CMS approval for a conservative Medicaid expansion model.

Democrats generally have shied from directly defending the ACA and running ads on healthcare issues. In Pennsylvania, Democrat Tom Wolf has stressed his support for expanding Medicaid but hasn't made the ACA a major focus of his ads, said Neil Oxman of the Campaign Group, a Philadelphia-based media firm. Wolf's campaign has focused on Corbett's public education cuts and his refusal to tax the oil industry for hydraulic fracturing, he said.

In Maine, where Democrat Mike Michaud is running against GOP Gov. Paul LePage, a tea party stalwart, and independent Eliot Cutler, Michaud has hit LePage hard for vetoing the expansion of Medicaid approved by the state Legislature.

However, neither Michaud nor Cutler, who both support the ACA, have released ads focusing on healthcare, said Amy Fried, a political science professor at the University of Maine.

“Jobs and the economy have been more of a focus here,” Fried said. Medicaid and healthcare have come up prominently in the debates, however.

In Alabama, even though polls show strong support for Medicaid expansion and a state-run exchange, Republican Gov. Robert Bentley has a 30-point lead in the polls against Democrat challenger Dr. Parker Griffith.

“Bentley continues to conflate Medicaid with being on the 'welfare roll' and 'dependent on government',” said Dana Patton, an associate professor of political science at the University of Alabama. “That kind of rhetoric seems to be effective in Alabama, despite the large number of poor people who would benefit from receiving Medicaid, many of whom work in low-wage jobs.”

In solidly blue states that have expanded Medicaid and established state-run exchanges—such as Colorado, Connecticut, Hawaii and Rhode Island, where polls show tight gubernatorial races—even if Republican candidates win, they likely would leave things as they are, said Deborah Chollet, a senior fellow at Mathematica Policy Research.

“At this point, healthcare providers and insurers have come onboard, and there are people living every day with Obamacare,” she said. “They don't want to see it go away.”