Dec 15, 2017 - Health Care

How the elections could put the brakes on anti-ACA plans

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.

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.

What's next

With Kansas deal, Medicaid expansion marches on

Illustration: Sarah Grillo/Axios

Kansas will likely become the 37th state — 38th if you count D.C. — to expand Medicaid under the Affordable Care Act.

Driving the news: The state's Democratic governor and Republican Senate leader announced a deal yesterday to expand the program, though it still needs to get through the state legislature.

Study: Medicaid expansion helps improve infant mortality rates

A newborn baby in the intensive care unit. Photo: Anton Novoderezhkin\TASS via Getty Images

Medicaid expansion and other social services help improve infant mortality rates, according to a new report from the liberal Center for American Progress.

Why it matters: The U.S. is ranked 55th in the world on infant mortality — alongside Serbia.

Health policy in 2020 will be made in the states

Illustration: Aïda Amer/Axios

With legislation in Congress likely to be blocked by partisan division and interest group opposition, much of the real action in health care this year will be in the states.

The big picture: States don’t have the money or purchasing power the federal government does, but their decisions nevertheless affect millions of people, and they could signal the future of federal reform.