Voters have made it clear that health care is the most important issue for them this election, and maintaining protections for insurance shoppers with pre-existing conditions has emerged as a key subject. But a range of other health issues could also be affected by the outcome of the midterms.
The New York Times looks at a number of health care questions that are being put to voters through ballot initiatives — everything from abortion to opioids to soda and tobacco taxes. And Modern Healthcare (registration required) offers its own breakdown of four areas where the election could shape how states will deal with health care even as gridlock continues in Washington.
But the future of these three big policies and programs are also on the ballot, in one way or another:
The Affordable Care Act: Protections for patients with pre-existing protections are only one part of the law facing some uncertainty. Sen. Majority Leader Mitch McConnell said this month that Republicans, unhappy with the way Obamacare is working and disappointed by their failure to overturn the law, could revisit their repeal-and-replace efforts. “If we had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks,” he told Reuters.
Conservative health care strategist Chris Jacobs told Kaiser Health News that, even if Republicans manage to keep control of the House, they likely won’t have the votes necessary to push through another repeal effort. The same might be true of the Senate. And if Democrats take the House, “any attempt at repeal-and-replace will be kaput,” John McDonough of the Harvard School of Public Health, a former Democratic Senate aide who helped write the ACA, told Kaiser’s Julie Rovner.
Medicaid Expansion: Seventeen Republican-led states have not expanded Medicaid as allowed under the ACA. Four states — Nebraska, Idaho, Utah and Montana — are putting Medicaid expansion up for a vote this year via ballot propositions. (Montana has already expanded Medicaid, but its ballot question would eliminate the 2019 expiration date set as part of its 2016 expansion and institute a tobacco tax to help pay for the costs.) The Florida gubernatorial race could also help decide whether the state expands Medicaid and extends coverage to an estimated 700,000 people. Similarly, races in Georgia, Kansas and several other states could determine the future of Medicaid expansion.
Medicare: After McConnell recently pointed to programs like Medicare, Social Security and Medicaid as the real drivers of long-term national debt, Democrats seized on his remarks and warned that the future of the health care program is on the ballot. “A vote for Republican candidates in this election is a vote to cut Social Security, Medicare and Medicaid,” Sen. Chris Van Hollen (D-MD) said recently. Republicans, meanwhile, have embraced the talking point that Democratic “Medicare for all” proposals would destroy the existing program for seniors and would really be “Medicare for none.” Those themes are bound to extend into the 2020 election cycle, but next Tuesday’s results could provide some indication of which argument voters are buying.