Medicaid expansion was on the ballot in several states, but several governors races may wind up being just as important to the future of the Medicaid program in several battleground states.
As Paul LePage so aptly demonstrated in Maine, the governor can have a huge impact on a state's Medicaid future, even in cases where the voters have been crystal clear about their preferences.
Several states including Kansas and Wisconsin saw notable upsets where Democrats nabbed an improbable victory that will likely make Medicaid expansion a priority moving forward. Several other states, including Florida, South Dakota and Oklahoma, remained in control of Republicans that have resisted expansion efforts.
These individuals will have a huge impact on the future of Medicaid in their states, although divided government in some statehouses could also stand in the way of new action. Let's dig in:
Georgia
The race for governor is still too close to call as of Wednesday morning, though Republican candidate Brian Kemp had 50.5% of the vote with 99% of precincts reporting. Democratic candidate Stacey Abrams had not yet conceded the race, telling CNN that there are still mail-in votes that hadn't been counted.
The race was shrouded in controversy, with Secretary of State Kemp facing voter suppression allegations throughout his campaign and some Georgia precincts reporting hours-long wait time because voting machines were not working.
If he holds onto victory, it likely defeats any prospect of Georgia expanding Medicaid, at least in the near term.
Kemp argued that the state can't afford to expand Medicaid, even with the federal government picking up 90% of the tab. He pointed to an analysis by the Robert Wood Johnson Foundation that showed the Medicaid expansion would cost Georgia an additional $200 million a year (PDF).
Abrams, meanwhile, promised to expand Medicaid "on Day 1" during the campaign, but with the state legislature still in Republican hands, she would face an uphill battle to do so, a prospect that didn't appear to daunt her during the campaign.
"I spent 11 years in the state legislature, seven as Democratic leader and I know how to work across the aisle,” she said in a recent debate. She also pointed to certain red states that have passed the expansion (albeit with work requirements, like in Indiana and Wisconsin) as evidence she can get the job done.
Florida
Overcoming a significant deficit in recent polling, Ron DeSantis surged forward to take the governor's mansion in what was a tight race to the end. DeSantis has been a vocal opponent of the Medicaid expansion during the campaign—and his presence doesn't change much given the politics of the state.
DeSantis won by just 56,000 votes over Democratic candidate Andrew Gillum, who took a progressive stance on healthcare during the campaign, endorsing both Medicaid expansion and Medicare for All.
The legislature last considered (and rejected) Medicaid expansion in 2015, and with the Republican lead in the State Assembly growing since then, there hasn't been much interest in revisiting it. Even with the modest gains Democrats made in the state assembly, Republicans still control a commanding lead with 69 Republicans taking seats in the State House and 15 winning seats in the Senate to Democrats' five.
Kansas
It's not unheard of for Democrats to win in Kansas, but it is rare. Yet that's what Laura Kelly accomplished in her race against unpopular Secretary of State Kris Kobach, winning by a margin of just over four points, getting 47.8% of the votes. Medicaid expansion was a major issue in the race, as the state's reluctance to expand has kept coverage from 150,000 Kansans.
Kelly promised to pass the Medicaid expansion in her first year, and the state legislature has shown some flexibility toward the proposal. A bipartisan majority in the legislature actually voted for the expansion in 2017, but then-Governor Sam Brownback vetoed it.
With a new governor in the state, it remains to be seen if the legislature has the appetite to try again.
Maine
Maine's gubernatorial race was a huge factor in whether the state expands Medicaid—arguably more so than in any other state. That's because Maine voters overwhelmingly backed the expansion in a 2017 ballot referendum, but current Gov. Paul LePage stood in the way for the remainder of his term.
With Janet Mills now elected as the state's new Democratic governor, that roadblock has officially been removed. Expanding the program will make 70,000 Mainers eligible for the program. Mills beat her Republican counterpart Shawn Moody by almost seven points, grabbing 50.3% of the votes in Maine.
Mills promised to immediately enact the expansion provision—which has stayed in the official registry even though it was never implemented. This is truly something that she can do on day one.
South Dakota
South Dakota has not been fertile ground for the Medicaid expansion, with the state pushing for work requirements even as it rejects expansion. That trend shows no sign of changing with the election of Republican Kristi Noem who won 51% of the vote on Tuesday to Democratic candidate Billie Sutton's 47.6%.
In Congress, Noem consistently fought against the Affordable Care Act and argued that the Medicaid expansion would drown state programs. Medicaid expansion "forced upon the state leaves fewer dollars for K-12 education, law enforcement, and other existing state programs. Even worse, the health law also prohibits the state from making changes to the program in an effort to increase efficiency," she wrote in a 2012 op-ed.
Wisconsin
With Democrat Tony Evers' victory over Scott Walker, Medicaid expansion has become a likelier proposition in the state than it ever has before. But the gubernatorial election also comes at an interesting time, with CMS recently approving the state's waiver to implement work requirements in its Medicaid program. Thus, even if Evers is able to move Medicaid expansion to the table, it may be under a very different context.
Evers squeaked out a victory Tuesday with 49.6% of the votes. Just over 30,000 votes separated the two candidates.
Evers appeared confident in the prospects for expansion, even though Republicans in the state legislature have expressed their opposition clearly. When Republican Assembly Speaker Robin Vos was asked whether he could broker a deal if Evers won, he said "No way. Never," according to U.S. News. But that hasn't deterred Evers' optimism.
“It’s easy … in the political time of an election to make comments like that,” Evers told Politico after a recent rally in Milwaukee. “I feel confident going forward we will be able to work with the legislature to make that happen. We have to get those resources, and we’re going to get it."
Oklahoma
Kevin Stitt, the Republican businessman who just won Oklahoma's governor's race, doesn't just disagree with the Medicaid expansion—he thinks too many Oklahomans are on Medicaid as it is.
“We’ve got to also audit our rolls. We’ve got to get those folks that should not be on our system off our system,” he told Oklahoma Engaged.
Stitt won a decisive victory on Tuesday, finishing 12 points ahead of his challenger, Democrat Drew Edmondson.
Medicaid expansion has been on ice in the state since current Gov. Mary Fallin decided against it in late 2012. Edmondson, called that move "the worst decision the governor made since taking office." However, his support for the expansion wasn't quite enough to win him the victory in this ruby red state.