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Medicaid at issue in 2019 races for governor

Republicans in Kentucky, Mississippi and Louisiana vow to scale back or block expansion

Louisiana Democratic Gov. John Bel Edwards touts his expansion of Medicaid, while his GOP opponent, Eddie Rispone, would freeze enrollment. (Joe Raedle/Getty Images file photo)
Louisiana Democratic Gov. John Bel Edwards touts his expansion of Medicaid, while his GOP opponent, Eddie Rispone, would freeze enrollment. (Joe Raedle/Getty Images file photo)

Races next month for governor in three states could affect the medical coverage of hundreds of thousands of people and offer test cases of how voters might view health care issues — particularly Medicaid for lower-income people.

In Mississippi, the Democratic candidate vows to expand Medicaid under the national health care law, while the Republican opposes that. Kentucky GOP Gov. Matt Bevin wants to scale back coverage that his Democratic opponent’s father, a former governor, expanded. And in Louisiana, incumbent Democratic Gov. John Bel Edwards touts his expansion of Medicaid while his GOP rival would freeze enrollment.

All three races are competitive. Inside Elections with Nathan L. Gonzales rates those in Kentucky and Louisiana as  Toss-ups. The Mississippi race is rated Leans Republican.

The contrast between the Kentucky candidates’ positions underscores the role of health care in the election and in voters’ lives. Bevin has sought to require many Medicaid consumers to prove that they work or volunteer by reporting their hours, or risk forfeiting their coverage. Those work requirements are on hold, tied up in a federal lawsuit.

If Medicaid benefits were rolled back in the future, that could have a political impact, said Al Cross, director of the University of Kentucky’s Institute for Rural Journalism and Community Issues.

“In this state, the benefit having been extended, there’s a real political price to pay if you take it away,” Cross said.

Medicaid reached new popularity after Republicans in Washington unsuccessfully sought to cap funding. A Kaiser Family Foundation poll in March 2018 found 74 percent of respondents approving of the program jointly funded by the federal and state governments and run on the state level.

“People are more favorably disposed towards Medicaid after the debates we’ve had about cutting Medicaid nationally,” said Adam Searing, an associate professor of the practice at the Georgetown University McCourt School of Public Policy’s Center for Children and Families. “Now, I think you do see more Democrats being willing to really put Medicaid up front in their campaigns and talking about it.”

States make some decisions about which residents qualify for Medicaid within their areas. So far, 36 states and the District of Columbia have decided to expand Medicaid for people with incomes of up to 138 percent of federal poverty, as the health care law allows.

Both parties are seeking to use health care concerns to their advantage, both this year and going into next year’s elections.

In Mississippi, which did not expand eligibility, the debate mirrors similar scenarios in conservative-leaning states since the 2010 law’s implementation. Democrat Jim Hood, the state attorney general running for governor, supports expanding the program. His Republican opponent, state Lt. Gov. Tate Reeves, is fighting expansion.

The Louisiana and Kentucky races show how Medicaid remains a political flashpoint even after state expansions. Republicans in both states propose scaling back the program in different ways.

“It’s not on the issue of expanding Medicaid but how to expand Medicaid,” said Capri Cafaro, an adjunct professorial lecturer at the American University School of Public Affairs and former Ohio Democratic state senator. “That’s where we’re seeing the differentiation.”

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Kentucky campaign

Bevin’s work requirement policy is opposed by his Democratic challenger, state Attorney General Andy Beshear, who said he would eliminate them on his first day in office. Beshear’s father, Steve Beshear, expanded Medicaid by executive order as governor in 2014.

The Republican Governors Association released a television ad in mid-October calling the younger Beshear “extreme on health care.”

The ad features a moment from a Democratic presidential debate earlier this year, when 10 candidates raised their hands in support of providing coverage to immigrants in the country illegally, an image that Republicans pounced on.

“Just like Bernie Sanders and Elizabeth Warren, Andy Beshear is pushing a liberal agenda that will ultimately burden hardworking Kentucky families,” RGA spokeswoman Amelia Chassé Alcivar said. “Kentucky voters want a governor who represents their values — not the extremes of the national Democratic Party.”

Kentucky GOP Gov. Matt Bevin and allied groups have tied his opponent Andy Beshear to national Democrats. (Screenshot/Putting Kentucky First/YouTube)
Kentucky GOP Gov. Matt Bevin and allied groups have tied his opponent Andy Beshear to national Democrats. (Screenshot/Putting Kentucky First/YouTube)

Beshear’s ads attack Bevin on health care issues, including one spot saying the incumbent wants to take away health care coverage.

Frederick Isasi, executive director of the consumer group Families USA, predicted that Medicaid expansion could be a deciding issue in the Nov. 5 Kentucky election. A majority of Americans tell pollsters health care is too costly and vote based on that issue, he said.

Isasi added that when governors like Bevin “actually make health care less accessible, they put more financial burden on families.”

Louisiana debate

In Louisiana, where expansion is popular, Edwards notes that expanding eligibility was his top priority when he was elected in 2015. Before the state’s jungle primary earlier this month, Republican challenger Eddie Rispone called for blocking new enrollment and checking that people enrolling in the program actually qualify for benefits.

Although Edwards won the most votes in the primary, the Nov. 16 runoff could be different. Edwards took 47 percent of the vote, but Rispone and third-place finisher Rep. Ralph Abraham combined for a majority with 27 percent and 24 percent, respectively. 

While Rispone has not proposed overturning Medicaid expansion, his plan to freeze enrollment would reverse the growth in benefits the state’s residents have enjoyed, warns the Louisiana Budget Project, a think tank focused on low- to moderate-income families.

“Although Rispone has provided no details about his plan, the experience of other states shows that an enrollment freeze would reverse the dramatic gains in coverage that Louisiana has seen since Medicaid was expanded in 2016,” the group warned.

The state’s conservative Pelican Institute for Public Policy argues that freezing enrollment would save Louisiana between $56 billion and $64 billion within a decade.

“We’re going to go in there and get rid of the abuse and the waste,” Rispone said in a pre-primary debate. “We keep expanding it. We can’t keep doing this because then we’re going to lose the safety net.”

In that debate, Edwards said the Trump administration had named Louisiana one of the eight states best equipped to root out Medicaid fraud and abuse. He said expansion helped the state, while neighboring states missed out on its financial benefits.

“Not a single hospital has closed in Louisiana, unlike other Southern states that didn’t expand,” he said.

Hospital closures

In Mississippi, Hood and other expansion advocates have sought to underscore that providing benefits to more people, and winning federal dollars for that, could help keep rural hospitals open.

A Navigant Consulting report released this year found the state could be one of the most affected by hospital closures.

“I’ll work with both parties to keep rural hospitals open, expand health care and create 9,000 jobs,” Hood said in a September ad.

The state’s hospital association is pushing lawmakers to seek a federal waiver to expand Medicaid by levying taxes on hospitals and consumers’ premiums to help finance expansion.

“The impact of Medicaid expansion on our rural hospitals is significant,” said Richard Roberson, the Mississippi Hospital Association vice president of state advocacy. “They’re the ones that are treating the uninsured in their emergency rooms, and they’re not getting compensated for it.”

Mississippi officials have long opposed expanding eligibility, citing cost. States would pay 10 percent of the costs, while the federal government pays 90 percent.

The Medicaid fights in the three states could spill over to 2020.

“Health care is going to continue to be a leading issue amongst voters across the country, particularly independent-leaning voters,” said Cafaro, the former Ohio state senator.

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