Obamacare’s Medicaid expansion has lately been making progress in unlikely places like Wyoming, where Republicans are being slowly swayed by business groups that it is a good financial deal for their state. But the quickest way to bring Medicaid expansion to the 23 states that have declined it so far would be a new state legislature or governor.
The former can be a little harder to anticipate. And according to some handicapping by Governing magazine’s Lou Jacobson, it doesn’t look like any legislatures are going to flip in a way that would have serious repercussions for Medicaid expansion, anyway, absent a change in the governor’s house. Gubernatorial races, on the other hand, get a lot of national attention and as the head of the executive branch, governors have an outsized influence on the fate of Medicaid expansion.
So here are the five states where, if a Republican incumbent falters in November, Obamacare would have an opening.
WISCONSIN: Gov. Scott Walker (R) vs. Mary Burke (D)
This might be the most closely watched governor’s race of the fall, and Walker currently holds only the slimmest advantage, according to TPM’s PollTracker average. It’s also a campaign where the two candidates have sparred over Walker’s decision to decline Medicaid expansion and its funding. The state instead restructured its existing Medicaid program, costing the state more than $100 million over two years, according to the Milwaukee Journal-Sentinel.
“Scott Walker’s decision was fiscally irresponsible and political. He cost the state millions of dollars and made health care less affordable,” Burke said last month. “Accepting the Medicaid expansion should have been the most fiscally responsible decision that Governor Walker ever faced.”
Wisconsin is one of those states where the governor can accept or reject Medicaid expansion. Burke has pledged to reverse Walker’s decision if she were elected.
MAINE: Gov. Paul LePage (R) vs. Mike Michaud (D)
Le Page might be the tea partiest of the GOP governors elected in 2010, and he has railed against expanding Medicaid, vetoing bills approved by his legislature three times. He called it “sinful” during one public appearance in May. But he’s also losing to his Democratic opponent, Rep. Mike Michaud, by 3.5 percentage points, according to TPM’s PollTracker average.
Michaud, meanwhile, helped found a Medicaid expansion caucus within the U.S. House in July. “Extending reliable, affordable healthcare to Mainers who need it isn’t just the right thing to do, but it’s also sound policy,” he said in a statement.
And if its three prior votes were any indication, Michaud would have an amenable legislature to work with. Medicaid expansion would cover up to 24,000 people in Maine.
Florida Gov. Rick Scott (R), then governor-elect, and his 2014 Democratic opponent Charlie Crist, then-governor, in 2010. (AP Photo/Steve Cannon).
FLORIDA: Gov. Rick Scott (R) vs. Charlie Crist (D)
Scott has more or less defined his political persona by his opposition to Obamacare — though he gave at least token support to Medicaid expansion last year — while former governor Crist has taken up the expansion banner as part of his conversion from Republican to Democrat. The race is tight, with Scott holding a 2.7-percentage-point advantage, according to TPM’s PollTracker average.
Crist has been relentless in pushing Medicaid expansion as an issue, going so far as to pin Scott with the blame for uncovered people’s deaths. “That’s why I’m running against Rick Scott, because he’s not a good servant,” he said earlier this year.
Despite Scott’s lukewarm endorsement, he did little to lobby for Medicaid expansion and the Florida House rejected it last year. So if Crist won, he’d have some work to do. But he would have a presumed mandate from voters and the support of the GOP-led Senate, which did sign off on expansion in 2013. It is not unthinkable that he could bring the House around and expand Medicaid to more than 750,000 Floridians.
KANSAS: Gov. Sam Brownback (R) vs. Paul Davis (D)
For the moment, state Sen. Davis is looking like he could pull the upset of the 2014 cycle: He leads Brownback by 6 percentage points, according to TPM’s PollTracker average. And he’s prevailing in deep-red Kansas despite his public support for this key piece of President Obama’s hated health care reform law.
“Our taxpayer dollars are just going to other states,” Davis said in March. “We need to do this. It’s the right thing to do.”
But in Kansas, even after a Davis win, things get tricky. Apparently anticipating this possibility, the Republican-controlled legislature passed and Brownback signed a bill that would prevent the state’s governor from expanding Medicaid unilaterally, as he or she would otherwise have been able to do. The legislature seems set to stay Republican, according to Governing’s Jacobson.
So Davis would have to convince a skeptical general assembly. But, like Crist, he would have some political capital via his recent election to push for expanding coverage to 78,000 Kansans. There are also growing examples, like Wyoming, of solidly conservative states coming around under pressure from business interest groups, like hospitals.
GEORGIA: Gov. Nathan Deal (R) vs. Jason Carter (D)
Deal, too, is facing an unexpectedly robust challenge. TPM’s PollTracker average currently shows Deal with a 3-percentage-point lead over Carter, a state senator and grandson of President Carter. Like Kansas’s Davis, Carter is making that strong push while still embracing a central component of Obamacare, which would extend coverage to more than 400,000 Georgians.
“It’s incredibly important for us to look at the fact that the federal government has $9 million of our tax money they keep every day,” he said in June. “There’s $30 billion in expansion funds that we’ve paid – it’s our money and Nathan Deal wants Washington to keep it. That doesn’t make sense to anyone, certainly not here.”
But like in Kansas, Carter would face an additional obstacle put up by Deal and the legislature, taking the power to expand Medicaid away from the governor and putting it in the hands of the legislature. That legislature is also expected to remain Republican, according to Governing’s Jacobson.
Georgia’s GOP lawmakers might be persuaded to cut a deal, though. One of their own is already passionately pushing for expansion. Even more than Kansas, the political environment in Georgia is changing. It is not outside the realm of possibility that the state elects a Democratic governor and U.S. senator this year.
Those are the pressure points then that Carter would have to rely on to get a Medicaid expansion deal passed.