Monday, September 17, 2018

Congressional races are all about "pre-existing conditions." Gubernatorial races spotlight Medicaid

Last week I wrote about how Democrats running in red states use "protection for people with pre-existing conditions" as a proxy for defending the ACA as a whole. In many states, Democrats still can't call the ACA by its name or discuss its actual programs. For example, in an ad that's gone viral, Joe Manchin never mentions the ACA -- or the ACA Medicaid expansion that has cut West Virginia's uninsured rate in half.  He's not alone.

Today brings two articles on how the healthcare debate is shaping up in races across the country. One qualifies my claim a bit; the other corroborates it.

In Huffington Post, Jonathan Cohn spotlights three gubernatorial races -- in Michigan, Ohio and Nevada --  in which the Democratic candidate is openly attacking the Republican for opposing Medicaid expansion, while the Republican is repudiating that past rejection. These are purple states, at least historically, that have increased their Medicaid enrollment by 1.3 million collectively since mid-2013. They've cut their combined uninsured populations from 2.9 million in 2013 to 1.5 million in 2017. according to Census survey results released this month.  Now, Republican candidates Schuette (Michigan), DeWine (Ohio) and Laxalt (Nevada) have all pledged to preserve the expansion, notwithstanding their prior opposition to it. In the governor's races, the expansion is an open topic of discussion.

Contrast that with the array of Democratic ads the New York Times' Margot Sanger-Katz puts on the wall in a look at House and Senate races in mostly red states. Joe Manchin (WV), Clarke Tucker (AR-2), Heidi Heitkamp (ND), Elissa Slotkin (MI-8), Claire McCaskill (MO), Joe Donnelly (IN), and Kim Schrier (WA-8) sing from the same psalter: they will protect coverage for people with pre-existing conditions (e.g., in several cases, their own or their family members'). Not one of them mentions the ACA or Obamacare by name or references Medicaid or subsidized insurance in the ACA marketplace Only Jacky Rosen in Nevada, hitting Dean Heller for "falling in line" behind Trump and supporting repeal of Obamacare, mentions the law by name (and does not mention pre-ex).

Partly, this contrast may be an accident of selection. Perhaps, though, it stems from governors' direct accountability for the delivery of services in their state -- not to say their control, or at the least, powerful influence, over whether their states embrace the ACA Medicaid expansion.

Do gubernatorial race tend to be more concrete than Congressional ones? I don't know, but the evidence here suggests they might.

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