Georgia Democratic gubernatorial nominee Stacey Abrams, whose family was uninsured when she was growing up, says she's running to “expand Medicaid and keep hospital doors open.”
Accepting the Affordable Care Act expansion would bring in $3 billion in federal funding a year and cover nearly 500,000 Georgians.
She's one of several Democratic gubernatorial candidates making a similar pitch in states that have not extended Medicaid to low-income adults as allowed by the ACA. Others are Andrew Gillum in Florida, Laura Kelly in Kansas, and Janet Mills in Maine. All are locked in tight races against Republicans who strongly oppose expansion.
The future of Medicaid has a lot riding on the November elections. Voters in eight states that haven't expanded Medicaid will choose a new governor for an open seat, with pollsters giving Democrats favoring expansion a solid chance of scoring pickups. Democrats also are expected to gain seats in a number of state legislatures, making expansion more likely in states like North Carolina where the governor wants it.
Advocates see election successes this November as a springboard to expanding Medicaid in nearly all 50 states. And the single-biggest factor in winning expansion in balky states like Alaska, Louisiana and Virginia, they say, has been the election of a governor who supports it.
“These state elections profoundly matter for Medicaid's future,” said Elliot Fishman, senior director of health policy for Families USA, a pro-expansion advocacy group. “They will shape the basic structure of Medicaid in both expansion and non-expansion states.”
Medicaid expansion opponents also see the elections as critical. They argue that Democrats are hurting their states by pushing for expansion, which they say neither the states nor the federal government can afford.
“In every state that expanded Medicaid, we have seen an unsustainable burden put on the backs of taxpayers and the crowding out of resources for people who are truly in need,” said David Barnes, policy manager for Americans for Prosperity, a conservative group that has lobbied states against Medicaid expansion.
Hospitals and other provider groups are supporting efforts to expand Medicaid, though they are keeping a low political profile in the election campaigns. They say expansion is critical to reducing uncompensated care and helping hospitals in rural and low-income areas survive. By not expanding Medicaid, “We're losing out on billions of federal healthcare dollars, with an impact on our economy, our workforce and ensuring access to care,” said Ethan James, executive vice president of external affairs for the Georgia Hospital Association.
In several states, Democratic and Republican gubernatorial candidates are facing off over whether and how to keep their state's expansion. Republicans such as Bill Schuette in Michigan and Mike DeWine in Ohio have flipped their prior positions and say they now support keeping expansion—but only with work requirements for non-disabled beneficiaries. Their respective Democratic opponents, Gretchen Whitmer and Richard Cordray, are strong expansion supporters who oppose work requirements.
In Alaska, Republican Mike Dunleavy, running against Gov. Bill Walker, an independent, and Democrat Mark Begich—both of whom favor keeping the state's Medicaid expansion in place—says he would review the program to find ways to reduce costs.