If Clinton Wins: Big Impact on Medicaid Expansion
While the 2016 gubernatorial race outcomes will obviously have a major impact of future of state Medicaid expansion under the Affordable Care Act (ACA) a bigger factor would be a Hillary Clinton victory over Donald Trump in the presidential race. “If Clinton wins, that will put a lot of questions about the future of the ACA to rest, and many states will re-look at the issue of expansion,” said Joan Alker, a Medicaid policy expert at Georgetown University, according to Modern Healthcare.
A Clinton victory, she added, would embolden more pragmatic GOP leaders who have been interested in expansion all along, such as Senate leaders in Florida and the governors of Georgia and South Dakota.
Democratic gubernatorial candidates in Missouri, North Carolina and Utah, for example, are arguing that the Republicans who currently control most of the levers of power in their states have hurt their residents by turning down the ACA’s federal contributions to expand coverage to adults with incomes up to 138% of the poverty level.
In North Carolina, where Republican Gov. Pat McCrory and Democratic Attorney General Roy Cooper are locked in a tight race, Cooper has attacked McCrory for blocking expansion based on conservative ideology. The governor has suggested he’s willing to consider it but the GOP-dominated Legislature has balked at extending coverage to the estimated 377,000 low-income residents who would qualify.
Montana, New Hampshire and North Dakota are states where Democratic candidates are fighting to protect their Medicaid expansions. In Montana, Democratic Gov. Steve Bullock, who pushed a conservative version of expansion through a GOP-controlled legislature, is in a close race with Republican Greg Gianforte, who previously has backed groups opposed to expansion.
The biggest prizes for Medicaid expansion supporters would be Democratic gubernatorial victories in Missouri and North Carolina, where Republican lawmakers have firmly rejected expansion under the ACA up to now. The Missouri Legislature overwhelmingly approved a recent, narrower expansion for people with disabilities or who are 65 or older. And North Carolina is in the midst of a major overhaul of its Medicaid program.
After the election in North Carolina, if a chastened Republican majority is facing a Democratic governor who wants to proceed with expansion and it senses that other Republicans across the country are signing up, it’s plausible. But GOP positions may dig in even deeper if we have a President Clinton — and especially if Trump follows through with his “rigged election” mantra, which will only inflame the GOP base voters to whom Republican officeholders answer.