Millions Without Health Coverage Hang on Gov Races
Policy + Politics

Millions Without Health Coverage Hang on Gov Races

The results of today’s midterm elections could have enormous implications for the president’s health care law—especially in states that have not expanded their Medicaid programs. 

Since a 2012 Supreme Court ruling gave states the right to choose whether to opt out of Medicaid expansion, 23 states—all with Republican governors --decided to pass on the program—with many saying it would be too costly and unsustainable for their states to handle. Under the law, the federal government fully funds the Medicaid expansion programs for three years, then at 90 percent thereafter.

Related: States of Health: Winners & Losers in Medicaid

The states’ decisions created a “Medicaid coverage gap” for people who did not meet states’ existing Medicaid income standards and were too poor to receive federal subsidies for the law’s exchanges. According to the Kaiser Family Foundation, some 5 million people are caught in this coverage gap.

The expansion is expected to cover childless adults, including low-income, able-bodied men and women over the age of 18. That is one reason some states are balking at the expanding the program, which in some states would mean reducing services to indigent families.

Today, 15 of these states have governors who are up for re-election. Six races are toss-ups --Alaska, Florida, Georgia, Kansas, Maine and Wisconsin. The election results could have an impact on uninsured people whose states opted out of Medicaid expansion. The New York Times notes that if a Republican governor is replaced by a Democrat or Independent in these states, it could mean “as many as 1.3 million more people will get health coverage in the years ahead.”

Even if a Democrat or Independent snags a victory in these states, they would still likely need approval from the state legislature to expand their Medicaid programs. Alaska, Florida and Georgia all have Republican-controlled state legislatures that have opposed expansion in the past and will likely do it again.

Related: The One Republican Who Wants to Keep Obamacare

In Florida, for example, the Republican controlled legislature has opposed Medicaid expansion legislation multiple times. So even if Democrat challenger former governor Charlie Crist beats Republican Gov. Rick Scott, getting the measure approved would be an uphill battle. Still, Crist has signaled that he would try to expand Medicaid through an executive order, as Ohio Gov. John Kasich did. Right now, more than 700,000 Floridians have fallen into the coverage gap.

In Georgia, where Republican Gov. Nathan Deal is in a tight race with Democrat state legislator Jason Carter, there are about 409,000 people trapped in the coverage gap. But Deal has repeatedly said he worries that his state doesn’t have the money to expand coverage. “I think that is something our state cannot afford,” Deal said to the Atlanta Journal Constitution. He added that it “is probably unrealistic to expect that promise (of federal funding) to be fulfilled in the long term, simply because of the financial status that the federal government is in.”

In Kansas, Gov. Sam Brownback who opposes Medicaid expansion is trying to stave off a challenge from Democratic state legislator Paul Davis. According to Kaiser Health News, there are about 78,000 people who would have coverage if the state expanded its Medicaid program. Still, like Florida, even if Davis wins, the Kansas Republican state legislature isn’t likely to approve a measure for Medicaid expansion anytime soon.

Alaska Governor Sean Parnell opposes Medicaid expansion and says most of the people who would benefit from it in his state are served by Indian Health Services or Veterans Affairs Department, according to The New York Times. His opponent, Independent candidate Bill Walker, supports expanding Medicaid. About 12,000 uninsured Alaskans fall into the coverage gap.

In Wisconsin, Gov. Scott Walker strongly opposes expanding Medicaid, while his Democratic challenger, Mary Burke, is a strong supporter. Wisconsin, for its part, already has more generous eligibility rules—so the coverage gap is not as dramatic as other states. 

Meanwhile, if the Democrats pull off a win in Maine and Michael Michaud defeats Gov. Paul LePage, the state will likely charge ahead with Medicaid expansion with the help of a Democrat-controlled state legislature. LePage has vetoed the legislature’s measures to expand Medicaid five times. But with Michaud as governor, about 24,000 people would likely qualify for coverage through Medicaid expansion.

Stay tuned for updates on the races at The Fiscal Times.

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