Midterm voters made it clear that health care issues mattered to them, even if it proved less than decisive in the outcome of some major races. A plurality of voters, 41 percent, told exit pollsters that health care was the most important issue for them, ahead of immigration (23 percent) and the economy (21 percent). Democrats chose to hammer Republicans on health care in their campaign messaging, with a particular focus on Obamacare’s protections for patients with pre-existing conditions, and the strategy largely worked — albeit with some notable exceptions.
“Democrats finally got their health-care revenge. The issue, more than any other, powered their majority win in the House of Representatives,” writes Jeff Spross at The Week. “The focus on health care in 2018 suggests that, at long last, health care broadly — and ObamaCare specifically — has the opportunity to become a winning political issue for Democrats.”
But the election may have also demonstrated some limits to that appeal. Here, three takeaways on what the elections results mean for health care:
1. Obamacare and the safety net status quo are safe. With Democrats taking control of the House, any further Republicans efforts to repeal and replace the Affordable Care Act would be futile. The New York Times Margot Sanger-Katz tweeted: “The biggest effects of Democratic control of the House is the things that probably won't happen in the next [two] years: There probably won't be another run at repeal and replace. There probably won't be Medicaid block grants. We probably won't be privatizing Medicare.” But Obamacare still faces a legal challenge in a federal district court in Texas, with the judge’s ruling due at any time now — and further court proceedings likely. Senate Majority Leader Mitch McConnell suggested Wednesday that Congress could still act to shore up Obamacare markets. "There are serious problems with Obamacare, serious problems that need to get fixed,” he said. “I think we are going to have to address that, now, on a bipartisan basis.”
2. Medicaid expansion will keep going. Voters in three Republicans states — Idaho, Nebraska and Utah — approved ballot measures that called for expanding Medicaid under the Affordable Care Act. Expansion in those states would extend coverage to more than 300,000 people — 150,000 in Utah; 90,000 in Nebraska; and 62,000 in Utah. (A measure to extend Medicaid expansion in Montana and pay for it through higher tobacco taxes appears to have failed.) Democrats also won gubernatorial races in Kansas, Maine and Wisconsin, making Medicaid expansion more likely to happen in those states. Maine voters last year approved a ballot initiative to expand Medicaid, but outgoing Republican governor, Paul LePage, blocked it. The ballot initiatives in Nebraska and Idaho did not lay out a way to pay the state share of expansion costs, The New York Times’ Abby Goodnough notes, adding, “That could potentially make them vulnerable to the type of stalling that’s happened in Maine.” Utah’s measure increases the states sales tax on non-food items from 4.7 percent to 4.85 percent to pay for expansion costs.
3. Democrats still face an internal fight over “Medicare for all.” Some Democratic candidates in tight, high-profile races embraced Medicare for all — and lost. “Of note for the Democrats, many of their most prominent progressive candidates, such as gubernatorial candidates Stacy Abrams (Georgia) and Andrew Gillum (Florida) and senatorial candidate Beto O'Rourke (Texas), lost their respective races,” analysts at IHS Markit wrote Wednesday. “The Democrats, therefore, will be more likely to jettison some of their more pronounced liberal policies such as ‘Medicare for All’ or a guaranteed USD15-per-hour minimum wage once they take power in the House in January 2019.” Progressives will point to how close those races were, in territory that’s traditionally been solid for Republicans, as evidence that those policies shouldn’t be dumped. And they’ll argue that more than half of Democrats in contested House races backed Medicare for all, and that worked out well for the party.
The debate will keep going through the 2020 election cycle, which, by the way, starts today.