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The eleven governors who were newly elected or re-elected on Tuesday night will soon have to publicly affirm their positions on several Affordable Care Act provisions, such as the law's Medicaid expansion. Most of the gubernatorial candidates had hesitated to state their positions on the expansion until after the election.
As of Thursday morning, winners have been declared in all 11 gubernatorial races, with seven Democrats and four Republicans winning victories:
- Delaware: Incumbent Gov. Jack Markell (D), who supports the expansion, defeated Republican Jeff Cragg;
- Indiana: U.S. Rep. Mike Pence (R)—who favors expanding Medicaid, but only if the state can limit benefits and ask beneficiaries to pay higher premiums—defeated Democrat John Gregg;
- Missouri: Incumbent Gov. Jay Nixon (D), who has not declared his position on the expansion, defeated Republican Dave Spence;
- Montana: Democrat Steve Bullock defeated Republican Rick Hill;
- New Hampshire: Democrat Maggie Hassan defeated Republican Ovide Lamontagne;
- North Carolina: Republican Pat McCrory, who opposes the expansion, defeated Democrat Walter Dalton;
- North Dakota: Incumbent Gov. Jack Dalrymple (R), who has not indicated his position on the expansion, defeated Democrat Ryan Taylor;
- Utah: Incumbent Gov. Gary Herbert (R) defeated Democrat Peter Cooke;
- Vermont: Incumbent Gov. Peter Shumlin (D), who supports the expansion, defeated Republican Randy Brock;
- Washington: U.S. Rep. Jay Inslee (D), who supports the expansion, defeated state Attorney General Rob McKenna (R); and
- West Virginia: Incumbent Gov. Earl Ray Tomblin (D) defeated Republican Bill Maloney.
When the Supreme Court upheld the ACA in June, the justices ruled that states can opt out of the expansion without any effect on current funding, essentially leaving the final decision up to each state's governor. So far, Republican governors in six states—Florida, Georgia, Louisiana, Mississippi, South Carolina and Texas—have announced that they will not participate.
Where does your state stand on the Medicaid expansion? Click to expand either a quick-to-scan graphic or an interactive graphic. (Note: interactive graphic may not be optimized for mobile devices.)
*Italics indicate a state's participation in the multistate lawsuit against ACA
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Under the ACA, the federal government would cover the full cost for the first three years of the expansion, which begins in 2016. However, analysts predict that the re-election of President Obama, coupled with intense lobbying by health advocates and the availability of billions of dollars federal subsidies, will persuade the six governors and other holdouts to move forward with the expansion and other provisions in the ACA, according to Kaiser Health News.
Kansas Insurance Commissioner Sandy Praeger, a former president of the National Association of Insurance Commissioners, said she expects states will try to negotiate more limited expansion options.
Paul Keckley, executive director of Deloitte’s Center for Health Solutions research group, said the Obama administration now also might be more willing to offer states more flexibility for some of the ACA provisions—or delay rolling out several of them—to ensure greater participation and success, Bloomberg reports.