- With Democrats’ victory in the House, Obamacare repeal is dead.
- Democrats hold a strong advantage on healthcare and Obamacare looks stronger than ever.
- Three deep-red states expanded Medicaid, a key part of Obamacare, via ballot initiatives.
- Other states where Democrats won the governors’ mansions could also undertake expansion.
Just two years after the future of the law was seriously in doubt, the results of Tuesday night’s midterm elections solidified Obamacare’s standing as the law of the land and showed that many aspects of the landmark healthcare law are getting more popular.
Democrats ran hard on the preservation of key aspects of the Affordable Care Act, a choice that many in the party credit for their House victory. A handful of states also voted to expand their Medicaid programs under Obamacare.
Democrats won the messaging fight on healthcare
With Democrats regaining control of the House, the GOP push to repeal and replace Obamacare is buried for the time being. If you ask Democrats, the prospect of another shot at repeal helped propel the party to victory.
Democratic Leader Nancy Pelosi, widely assumed to be the next speaker of the House, pointed directly to healthcare as the key to the party’s path to the majority.
“It’s about stopping the GOP and Mitch McConnell’s assault on Medicare, Medicaid, affordable health care, and millions of Americans living with pre-existing medical conditions,” Pelosi said during a victory speech, referring to the Senate majority leader.
The ACA is polling near its highest level ever. And many of the law’s provisions, including protections for people with preexisting conditions, remain significantly popular. The rising popularity and the GOP’s legislative attacks on Obamacare allowed Democrats to draw a stark contrast with their Republican opponents.
Healthcare ranked as the top issue for voters in exit polling, and Americans generally trusted Democrats more than Republicans. According to an exit poll of 75 competitive, GOP-held districts by the left-leaning Public Policy Polling, 52% of people said they trusted Democrats more on healthcare, compared to just 44% who trusted the GOP more.
The switch represents a huge change from the 2010 and 2014 midterms, when Republicans hammered Democrats on the ACA and healthcare in general.
An outstanding question, however, is what exactly Congress could do to shore up Obamacare in a divided Congress. A bipartisan push to reinforce the law’s individual insurance markets fell through in 2017, but McConnell hinted that another deal could be on the docket in 2019.
“We are going to have to try to address that on a bipartisan basis,” McConnell said.
Medicaid expansion is a winner
Perhaps most significant for Obamacare’s legacy is the continued popularity of the law’s Medicaid expansion. The ACA allows states to expand Medicaid eligibility to people making up to 138% of the federal poverty limit, helping low-income Americans gain access to healthcare.
Expansion is heavily subsidized by the federal government to ease the cost burden on states, but many state-level Republicans have rejected the idea due to budgetary concerns. But slowly, the protestations of the GOP are giving way to a gradual march of Medicaid expansion.
Three deep-red states – Idaho, Nebraska, and Utah – joined the 32 expansion states via ballot initiatives on Tuesday. Solid majorities in each state voted for expansion, which will help roughly 325,000 people gain access to Medicaid.
In addition to the direct pick ups for expansion, a couple of governor’s races could lead to additional gains:
- The Kansas legislature passed a bill to expand Medicaid in 2017, but it was blocked by then-Gov. Sam Brownback. Pro-expansion Democrat Laura Kelly took the governor’s mansion, which could allow another crack at expansion and open to door for around 150,000 more people to enroll in Medicaid.
- Tony Evers, the Democratic governor-elect in Wisconsin, could also accept federal aid to boost the state’s Medicaid program and extend coverage to another 176,000 people in the state.
- Additionally, Maine Gov. Paul LePage’s refusal to implement Medicaid expansion despite a 2017 vote in favour of the move will likely be broken by the new Democratic Governor-elect Janet Mills. 70,000 people in the state could be eligible for Medicaid if expansion moves forward.
Other states could see expansion, like in North Carolina, where Republicans lost their supermajority in the state legislature, but that remains less likely.
In total, with the ballot initiatives and governors’ races, up to 721,000 Americans could gain access to healthcare via Medicaid expansion in the wake of the midterms.