November 5, 2019

What today's elections mean for health care

Daily Briefing

    Gubernatorial and legislative elections being held Tuesday in Kentucky, Mississippi, and Virginia, as well as a gubernatorial election that will be held later this month in Louisiana, could decide whether hundreds of thousands of U.S. residents have access to Medicaid coverage.

    Slide deck: Medicaid 101

    Medicaid work requirements at stake in Kentucky, Louisiana

    According to Vox, the gubernatorial elections in Kentucky and Louisiana could determine whether the states restrict Medicaid coverage by keeping or implementing work requirements for the program.

    Health care advocates have argued that Medicaid work requirements impose barriers to coverage for low-income individuals and can cause coverage losses. But supporters of work requirements claim they help Medicaid beneficiaries find employment and can help to improve beneficiaries' overall health and wellbeing by lifting them out of poverty.

    Kentucky has received federal permission to implement Medicaid work requirements, but the requirements have been blocked by a federal court. Gov. Matt Bevin (R) has vowed to continue pursuing the requirements if he is re-elected.

    However, Kentucky Attorney General Andy Beshear (D), who is running against Bevin, opposes the work requirements. Instead, Beshear—the son of former Kentucky Gov. Steve Beshear (D), who expanded the state's Medicaid program under the Affordable Care Act (ACA)—said his "goal is to make sure every single Kentuckian has some form of [health] coverage, and that we lower the cost for every single Kentucky family."

    In Louisiana, where voters later this month will cast their ballots for governor, current Gov. John Bel Edwards (D) expanded Medicaid under the ACA in 2015 and has made protecting the program a main theme of his re-election campaign. In contrast, Eddie Rispone, Bel Edwards' Republican opponent, has said he wants to "freeze" enrollment in the expanded program to investigate alleged fraud and has expressed interest in implementing work requirements similar to those approved in Kentucky.

    According to Roll Call, "Inside Elections with Nathan L. Gonzales" has rated both Kentucky's and Louisiana's gubernatorial races as "Toss-ups."

    Medicaid expansion at stake in Mississippi

    Meanwhile, Medicaid expansion is a key issue at stake in Mississippi's gubernatorial race.

    Mississippi is one of the 14 remaining states that have not expanded their Medicaid programs under the ACA. According to Vox, Mississippi has one of the highest uninsured rates in the country, as well as the lowest median household income. As such, expanding the state's Medicaid program under the ACA could provide many state residents with health coverage and bring a large sum of federal funding to the state.

    Lt. Gov. Tate Reeves (R), who is running for governor, has said he opposes Medicaid expansion "on philosophical grounds." However, Attorney General Jim Hood (D), who is opposing Reeves, has said he would expand the state's Medicaid program if elected.

    According to Vox, "[a] Democrat winning a statewide race in Mississippi sounds unlikely, but the … (scant) polling has shown a tight race between him and … Reeves," and if Hood is elected, it "would send a clear signal about the potency of the Medicaid expansion as an issue."

    According to Roll Call, "Inside Elections with Nathan L. Gonzales" has rated the race as "Leans Republican."

    Medicaid eligibility and other coverage could expand in Virginia

    In Virginia, the results of elections for state lawmakers could determine whether some restrictions on Medicaid eligibility remain in place.

    Gov. Ralph Northam (D) expanded the state's Medicaid program in 2017, but the expansion includes some eligibility limits that were needed to get the plan approved by the state's Republican-controlled Legislature. Republicans currently hold two-seat majorities in both the state Senate and House of Delegates.

    According to Vox, if Democrats take control of the state's Legislature, it is possible that state policymakers could look to lift the eligibility limits included in Virginia's Medicaid expansion. A Democratic-controlled Virginia legislature could look to experiment with other types of health coverage expansions, as well, Vox reports (Yglesias, Vox, 10/29; Schreiner, Associated Press, 3/26; Collins, Vox, 11/4; McIntire, Roll Call, 10/30; Japsen, Forbes, 11/3; Romoser, Inside Health Policy, 11/4 [subscription required).

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