Voters in Montana will also decide whether to extend Medicaid expansion beyond 2019. Medicaid expansion has also made it onto the ballot in three states - Idaho, Nebraska, and Utah - giving voters the authority to decide whether their states will adopt the expansion. 5 Democratic gubernatorial candidates in both states support expansion and oppose adding work or other requirements. More recently, during the general election campaign, he has said Medicaid expansion is “the law” and “it’s not going anywhere.” 4 Next door in Ohio, Republican candidate Mike DeWine also retreated from opposition to Medicaid expansion following his primary win, indicating that he would maintain the program if work requirements are implemented. In Michigan, Republican candidate Bill Schuette, the current Attorney General, has long opposed the ACA in general and the Medicaid expansion in particular, vowing during the primary campaign to repeal the expansion. In addition, candidates in two key open gubernatorial races in states that have expanded Medicaid have softened positions on the Medicaid expansion since their states’ primaries. 2 3 Citing financial concerns and fears that it would be a step toward a single-payer health care system, Republican candidates in these states have opposed expanding Medicaid. Several Democratic candidates in red states where past efforts to expand Medicaid have stymied, particularly Stacey Abrams in Georgia and Laura Kelly in Kansas, tie Medicaid expansion to the future of rural health care in their states by arguing that Medicaid expansion will bolster rural hospital finances and prevent further rural hospital closures. In key races in Florida, Georgia, and Kansas, Democratic candidates have expressed support for Medicaid expansion as a way to increase coverage and improve access to care. Particularly in non-expansion states, gubernatorial candidates have staked out opposing positions on whether to adopt the expansion, largely mirroring the long-standing ideological divide surrounding the ACA. Medicaid expansion has been more prominent in gubernatorial races than in Senate races, though it has surfaced in key Senate races in Florida and Texas. States may implement the expansion at any time, and while they can no longer receive 100% federal financing for three years, they remain eligible for enhanced federal financing of 93% in 2019 and 90% in 2020 and beyond. To date, 34 states including the District of Columbia have adopted the ACA’s Medicaid expansion. While not typically an election issue, Medicaid - particularly the Medicaid expansion created under the Affordable Care Act (ACA) - has become an important issue in a number of campaigns throughout the country. Key Health Care Issues in Statewide Races and Ballot Measures Medicaid Expansion and Other Program Changes The aim of this review is to assess where health care issues have been a focus of the candidates, not to assess the impact of these issues on voters. The tables in the Appendix highlight which of these select health care issues have been prominent or served as topics of candidate debate in each of the 71 races for Governor and Senate a third table lists state ballot initiatives on these health care issues. 1 Based on a review of media coverage and political advertising by candidates during the current election cycle, this election update explores select health care issues being discussed by candidates in key gubernatorial and Senate campaigns across the country as voters prepare to go to the polls in November. Republican candidates, in contrast, are talking less about health care following their failed attempt to repeal and replace the ACA last year, focusing more on taxes and immigration in their ads. Democratic candidates, in particular, have made health care a central part of their campaigns and a focus of their political ads, highlighting popular provisions in the Affordable Care Act (ACA), including protections for people with pre-existing medical conditions. The issue is playing a prominent role in many House, Senate, and gubernatorial races, and health-related measures have made it onto the ballot in several states. With the 2018 midterm election season in full swing, health care has emerged as one of the top issues for voters.
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