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In the Voting Booth, Healthcare a Factor That Could Determine Race Outcomes
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In the Voting Booth, Healthcare a Factor That Could Determine Race Outcomes

Allison Inserro
With a preference for healthcare as the number one issue among Democrats and independents, the 2018 midterm election is being called a referendum on healthcare issues. But at the federal level, will healthcare become a gridlocked issue for the next 2 years of President Trump's first term?
With a preference for healthcare as the number one issue among Democrats and independents, the 2018 midterm election is being called a referendum on healthcare issues. But at the federal level, will healthcare become a gridlocked issue for the next 2 years of President Trump's first term?

FiveThirtyEight is predicting as much, seeing the Democrats taking the House of Representatives and Republicans hanging onto control of the Senate, possibly adding a seat to their current majority. 

Healthcare, especially issues related to the Affordable Care Act (ACA), is "devolving to the states," said Benjamin Isgur, who heads PwC's Health Research Institute, in an interview with The American Journal of Managed Care®.

Aside from individual candidates, Medicaid is on the ballot in 4 states. Medicaid provides healthcare to about 76 million low-income individuals, or about 1 in 5 Americans. The ACA allowed states to expand Medicaid eligibility to nonelderly adults with incomes up to 138% of the federal poverty level.

Although the expansion was originally intended to be enacted nationwide, in 2012 the Supreme Court ruled that states could opt out of it. Despite failed efforts by the Trump administration to repeal the ACA outright in 2017, the attempt actually wound up increasing the popularity of Medicaid.

In 3 states today, voters in Idaho, Nebraska, and Utah will decide whether their states will adopt the expansion. Montana voters will choose whether to extend Medicaid expansion beyond 2019. If the measures are approved, those states would join the 34 that have expanded the program.

Here’s a look at some races where healthcare concerns could make a difference in the outcome:

Governor’s Races

There are 14 tight governor’s races where the outcome could determine healthcare changes in those states, whether the topic is about Medicaid, protecting the pre-existing conditions of the ACA, or other possible changes, according to the Kaiser Family Foundation.

In Florida, Democrat Andrew Gillum, the progressive mayor of Tallahassee, favors expanding Medicaid and has embraced the idea of “Medicare for All,” which has become a rallying point for the left. Republican Ron DeSantis, a former congressman, does not and has also opposed the ACA.

FiveThirtyEight is forecasting a win for Gillum, as well as for veteran Democratic Senator Bill Nelson, who is being challenged by former governor and healthcare executive Rick Scott.

In Georgia, Democrat Stacey Abrams sees Medicaid expansion as a key piece of protecting rural hospitals, which have been closing at a rapid rate across the country. In fact, a study earlier this year found that states that embraced Medicaid expansion had fewer rural hospitals close than states that did not expand Medicaid.

Republican Brian Kemp, Georgia’s secretary of state, cites financial concerns and fear of expansion leading to a single-payer health system for his opposition to expansion. Kemp is considered to have an edge on Abrams.

Nevada’s race for the governorship between Democrat Steve Sisolak and Republican Adam Laxalt is considered a toss-up. The Senate race between incumbent Republican Dean Heller and Democrat Rep. Jacky Rosen is also neck and neck.


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