Searching for smart, safe news you can TRUST?

Support safe, smart, REAL journalism. Sign up for our Axios AM & PM newsletters and get smarter, faster.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Searching for smart, safe news you can TRUST?

Support safe, smart, REAL journalism. Sign up for our Axios AM & PM newsletters and get smarter, faster.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Denver news in your inbox

Catch up on the most important stories affecting your hometown with Axios Denver

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Des Moines news in your inbox

Catch up on the most important stories affecting your hometown with Axios Des Moines

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Minneapolis-St. Paul news in your inbox

Catch up on the most important stories affecting your hometown with Axios Minneapolis-St. Paul

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Tampa-St. Petersburg news in your inbox

Catch up on the most important stories affecting your hometown with Axios Tampa-St. Petersburg

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

The most important issue in an election is sometimes, but seldom, the factor that actually determines the outcome of the election. That's what we saw happen in Virginia this week. Health was the top issue in the Virginia race, according to exit polls, but it was only one of many factors that drove the election.

The bottom line: The election may have been more of a referendum on President Trump than health care — but the results in Virginia and in the Maine referendum on Medicaid expansion will still have a practical impact on what happens next, including the appetite for Affordable Care Act repeal and for cutting Medicaid to pay for tax cuts.

Expand chart
Data: Fox News voter analysis, Nov. 7; Chart: Axios Visuals

The details: Voters in Virginia named health care as far and away their top issue in the election in the network exit poll. It's not surprising that the issue was at the top of their minds; they have been hearing all about the ACA in the news for months and about Medicaid expansion in their state.

Yes, but: Notably, the exit poll did not include the economy on the list of issues voters could choose. Fox News did ask about the economy and, as the chart shows, it and health were statistically tied in their poll.

Between the lines: When voters rank health care as a top issue in an election, it does not necessarily mean health care drove their vote. Voters' views of the candidates themselves are generally a bigger factor. The candidates were also proxies for voters' feelings about President Trump, and many more voters in Virginia said they were voting to express opposition to Trump than their support for him (34% vs. 17%).

Most voters who chose health care as their top issue in Virginia voted for Northam, possibly signaling that Democrats may be able to campaign on health care and the ACA in upcoming elections.

What to watch: The Maine vote on Medicaid expansion was a different story. Maine voters cast their ballots on a specific referendum to expand the Medicaid program, and it won resoundingly. The result speaks to a lesson learned in the repeal and replace debate: Medicaid and Medicaid expansion are far more popular than Republicans seem to think they are, largely because Medicaid now covers 74 million Americans and matters to a broad cross section of the American people.

The impact: The immediate political implication is that it will be much tougher to cut Medicaid to help pay for tax cuts. Another lesson is that expanding Medicaid could be a winner in other states, especially with the federal government picking up 90 percent of the costs and the Trump administration ready to let red states put a conservative stamp on their programs. Medicaid is not Social Security or Medicare yet, but politically it is a lot closer than Republicans may realize.

A lot can and probably will happen between now and 2018. But for now, the prominence of health care in the Virginia election could throw a scare into moderate Republicans about continuing to pursue ACA repeal. And the Maine referendum on Medicaid expansion could make them more cautious about cutting Medicaid.

Go deeper

18 mins ago - Podcasts

Bob Nelsen on AstraZeneca and his plan to revolutionize biotech

AstraZeneca and the University of Oxford on Monday reported promising efficacy data for their COVID-19 vaccine, which has less stringent storage requirements than the Pfizer and Moderna vaccines and may be distributed earlier in developing countries.

Axios Re:Cap digs into the state of vaccine and therapeutics manufacturing with Bob Nelsen, a successful biotech investor who on Monday launched Resilience, a giant new pharma production platform that he believes will prepare America for its next major health challenges.

Ben Geman, author of Generate
Updated 25 mins ago - Energy & Environment

Unpacking Joe Biden's decision to tap John Kerry as his climate envoy

Photo: Pablo Blazquez Dominguez/Getty Images

President-elect Joe Biden is naming former Secretary of State John Kerry as a special presidential envoy for climate change.

Why it matters: The transition team's announcement sought to show that it will be an influential role, noting that Kerry — a former Massachusetts senator and the Democrats' 2004 presidential nominee — will be on the National Security Council.

Dave Lawler, author of World
2 hours ago - World

Oxford and AstraZeneca's vaccine won't just go to rich countries

Waiting, in New Delhi. Photo: Jewel Samad/AFP via Getty Images

While the 95% efficacy rates for the Moderna and Pfizer/BioNTech vaccines are great news for the U.S. and Europe, Monday's announcement from Oxford and AstraZeneca may be far more significant for the rest of the world.

Why it matters: Oxford and AstraZeneca plan to distribute their vaccine at cost (around $3-4 per dose), and have already committed to providing over 1 billion doses to the developing world. The price tags are higher for the Pfizer ($20) and Moderna ($32-37) vaccines.

Get Axios AM in your inbox

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!