The Democrats' predicted blue wave looks poised to hit the Republicans' red seawall, which means a big swath of the country could crash purple this midterm election cycle. For the healthcare industry, where stakes are higher at the state level over the next two years, that could mean the states will carry out the kind of bipartisan work that stymies Washington.
“Keep in mind how Washington under the Democrats and Republicans has been increasingly unable to get things done in a whole lot of areas,” Charlie Cook, editor of Cook Political Report, told the Medicaid Health Plans of America conference in Washington last week. “That has left a power vacuum that has devolved power out to state governments.”
As congressional Republicans and Democrats remain gridlocked over changes to the Affordable Care Act, the Trump administration is giving states more leeway to reshape their individual markets. The CMS is also encouraging state-level overhauls of Medicaid with an eye toward shrinking costs.
This comes as Democratic gubernatorial candidates in red and purple states run on Medicaid expansion. These opposing factors set the stage for significant policy changes that could mingle Republican and Democratic ideas.
Currently the governor and legislature in 26 states are Republican, with 13 states of those rated at various degrees of vulnerability. The same is true in eight states for Democrats, with five also considered vulnerable. But now more than 6,000 state legislative seats are up for grabs. Nearly a third of the races for the 36 open governorships are toss-ups—including Florida, Iowa and Wisconsin.
Here's a look at how Nov. 6 could change things: