Democrats running in five highly competitive governors races this year have vowed to expand Medicaid coverage through ObamaCare if they are elected, something that could result in 1.7 million new people getting covered.
The dramatic stakes in the governors’ races come even as Democrats are fearful they could lose the Senate, leaving President Obama playing defense over the final two years of his presidency against a Republican Congress.
The positions of the two political parties flip, when it comes to the race to control state houses.
Republicans are favored to gain seats in the House and Senate, but the party is playing defense in the race for state houses.
Most congressional Democrats are retreating from ObamaCare on the campaign trail. The law remains a tough political litmus test at a time when the president’s approval rating has sunk to record lows.
But Democrats in some of the closest gubernatorial contests are running on a platform to expand a central piece of the law.
Medicaid expansion is a core issue in Florida, where the state’s one-time Republican governor, Charlie Crist, is now running as a Democrat and embracing Obama as part of his campaign.
Crist has pledged to take every step to capture more Medicaid dollars, even threatening a budget line-item veto against the GOP-controlled legislature that’s already blocked a similar effort. Florida stands to gain $66.1 billion over 10 years with the expansion, which is expected to cost about $5.3 billion over that time, according to The Urban Institute.
The Democrat’s sharp position on expanding Medicaid has called attention to the changing stance of current Republican Gov. Rick Scott.
Two years ago, Scott wrote in an op-ed that Medicaid expansion was “bad for states” because “we don't need the federal government telling us what to do when it comes to meeting the needs of the citizens of our states.”
With less than two months until the election, Scott now backs an expansion of Medicaid, at least for the first three years.
“I’m not going to stand in the way of the federal government doing something,” he told the Miami Herald last month.
Medicaid also has emerged as a centerpiece of this fall’s battle between Maine’s Republican Gov. Paul LePage, and his Democratic opponent, Rep. Mike Michaud.
Michaud, who voted to support ObamaCare in 2010, has pledged to expand Medicaid the first day he is sworn into office. LePage has already vetoed five different bills to expand Medicaid.
LePage now holds one of the lowest approval ratings of any governor in the country (41 percent), which a Michaud spokeswoman called proof that voters don’t back his approach to healthcare.
“The only thing stopping us from being able to expand access to care is one man — Gov. LePage,” the Democratic candidate’s spokeswoman Lizzy Reinholt said. “There’s no doubt that Republicans have tried to message it in a way that makes folks less likely to support it. But at the same time, the facts are clear.”
If Maine moves forward with its expansion, it could accept $3.1 billion in federal dollars over the next decade, according to a report released last month by The Urban Institute.
A wild card in the Maine race is an independent candidate, Eliot Cutler, who some observers think could cost Michaud the race. Cutler has said he also supports expanding Medicaid for Maine residents.
Democrats are able to back expanding Medicaid because it is popular.
Six in 10 voters in states that have not expanded Medicaid coverage believe all states should, according to a poll released Thursday by Morning Consult. Among Republicans in those states, 36 percent back the program expansions.
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Tom Scully, who served as head of the Centers for Medicare and Medicaid Services under former President George W. Bush, predicts all state governments will eventually agree to expand, regardless of party.
“I think as the Affordable Care Act becomes more entrenched and less likely to be repealed … I think, one by one, I think all the states will eventually do an expansion,” Scully said. He predicted that core conservative states like Mississippi and Idaho would be the last to approve expansions.
Jason Carter, the Democrat looking to unseat Georgia Gov. Nathan Deal, has argued that the state will lose billions of its tax dollars if it does not expand Medicaid.
“It’s our money, and Nathan Deal wants Washington to keep it,” Carter proclaimed during a campaign event this summer.
Carter, the grandson of the 39th president, has faced a half-million dollars worth of attack ads from the Republican Governors Association for his Medicaid stance.
But Carter has delivered a strong rebuttal: The leader of the Republican group, New Jersey Gov. Chris Christie, agreed to expand Medicaid in his state last year.
Christie is one of nine red-state governors to endorse the expansion, with three more likely to follow suit. Utah lawmakers announced this week that they are nearing a deal with federal officials on an expansion, and the governors of Tennessee and Wyoming have also begun negotiations.
Some state leaders remain hesitant to touch the issue of Medicaid, afraid to appear supportive of ObamaCare as a whole, said Stan Dorn, a senior fellow at The Urban Institute who authored the report.
“It’s hard to say, ‘Yes, I’m opposed to the Affordable Care Act, but this particular piece of it, I’m going to move forward with.’ It’s complicated,” he said. “If this particular expansion was provided in a different context, you’d no doubt see more state officials expanding it.”
Florida-based GOP consultant and pollster Rick Wilson said he takes issue with the way Democrats have described Medicaid expansions as “free money” from the federal government.
He argued that the federal dollars are still coming from taxpayers and warned that it could lead to greater spending in the future.
“The first crack from the dealer is always free,” Wilson said. “People are consistently confused why rational, fiscally conservative governors will sometimes take the crack. It’s sort of a natural human instinct.”