Republicans' big election gains Tuesday in governorships and legislatures around the country diminish but do not eliminate prospects that more states will expand Medicaid to low-income adults as allowed by the healthcare reform law, political analysts say.
Republicans now hold at least 31 governorships and full party control of state government in at least 23 states. A number of GOP governors who staunchly opposed Medicaid expansion, including those in Georgia, Kansas, Maine and Wisconsin, survived tough races; political observers say there is little chance expansion will go forward in their states in the near future. For instance, Gov. Scott Walker of Wisconsin, who has rejected federal funds to expand Medicaid, easily won re-election over a Democratic challenger who attacked him for not accepting the federal expansion funding. And Republicans strengthened their control of the Florida Legislature, making the already-long odds of expansion there even longer.
On top of that, Republicans who have expressed skepticism about Medicaid expansion won elections in Arizona and Arkansas to succeed governors who pushed through expansion. That raises the possibility of rollbacks in red states that already have implemented Medicaid expansion.
Prior to the election, Republican governors in Indiana, North Carolina, Tennessee, Utah and Wyo-ming, none of which had gubernatorial elections last week, had signaled cautious interest in expanding their state's Medicaid program to adults earning up to 138% of the federal poverty level. They indicated they wanted to explore conservative models typically featuring reliance on private health plans and requiring beneficiary premium contributions.
But expansion may be in doubt even in those states, given Republicans' broad ideological opposition to Obamacare and their new control of Congress. “It seems unlikely to me you would see additional movement toward expansion of Medicaid or any further implementation of the Affordable Care Act,” said Lee Weingart, a Republican political analyst.
So far, 27 states and the District of Columbia have expanded their programs, extending coverage to an estimated 8.7 million Americans over the past year. But there are an estimated 5 million more people living in the 23 non-expansion states who meet the ACA income threshold for coverage and remain uninsured.