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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Elections Next Month Critical for Public Health in Four States

From “Health care is on the ballot in state elections starting next week: Thousands of lives are at stake in mostly ignored upcoming elections” by Matthew Yglesias at Vox:

…A recent study from four researchers — University of Michigan economist Sarah Miller; University of California, Los Angeles public health scholar Laura Wherry; National Institutes of Health’s Sean Altekruse; and Norman Johnson with the US Census Bureau — estimates that failure to expand Medicaid leads to about 15,600 extra deaths per year just among people ages 55-64.

After the passage of the ACA, Democratic states mostly took the expansion money, adding over 7 million more Americans to insurance rolls in recent years. GOP-run states mostly didn’t, though a handful of GOP governors have accepted expansion funding but done so under waiver systems that let them impose heavy work requirements and other administrative burdens on recipients.

Originally, the ACA stipulated that states that failed to expand Medicaid would lose their existing federal funding, which would have made expansion all but inevitable. But a 6-3 Supreme Court ruling in which the five conservative justices were joined by Elena Kagan struck down that punitive aspect of ACA expansion as unconstitutional.

The decision set off a years-long series of state-by-state battles with very real stakes. Next week several of those fights are coming to a head.

Yglesias notes that November’s governorship elections in Kentucky, Mississippi, Louisiana, and Virginia will determine whether or not hundreds of thousands of low and moderate-income people in those states will have access to life-savng health care. He explains that “Leaders in the four states have rejected or put tough restrictions on extremely generous federal matching funds allocated under the Affordable Care Act (ACA) to extend their Medicaid programs to cover families earning up to 133 percent of the federal poverty level.” Democratic victories in those states would mean new hope for thousands of seriously-ill people in thiose states.

“In Kentucky and Louisiana,” Yglesias adds, “Republican candidates want to keep or set new work requirements for Medicaid recipients while Democrats want to lift or prevent them.” In Mississippi Democrats have “a strong candidate in longtime Attorney General Jim Hood, and the (scant) polling has shown a tight race between him and Lt. Gov. Tate Reeves…the mere fact that it’s such a long-shot race would send a clear signal about the potency of the Medicaid expansion as an issue.” In Virginia,

Republicans currently hold narrow two-seat advantages in both the state Senate and the House of Delegates, but [Democratic Governor] Northam carried strong majorities in districts for both houses during his 2017 election. That, plus strong fundraising and polling that seems to show Trump has become even less popular in Virginia over time, makes Democrats very optimistic about the ability to flip both chambers despite the cloud of scandal hanging over their statewide elected officials.

The implications of a possible flip in control are wide-ranging, especially that they include control over the redistricting process after the 2020 census, but, of course, extend to health care. A Democratic state legislature would likely lift those restrictions on eligibility and could even join other Democratic-run states in experimenting with larger expansions of government-provided health insurance.

“Virginia could be the perfect example of how Democrats, if they’re disciplined and take the long view, can flip a state legislature that’s been gerrymandered in two cycles,” says Chris Bachman, founder of Virginia Matters and a digital political consultant to several in the class of 2017, as well as some 2019 hopefuls,” Joan Walsh reports at The Nation. Walsh adds that women candidates and activists are leading the Democratic surge in Virginia, which provides “a test case of whether they could undo the damage of 10 years of ignoring state legislative races…Nancy Guy, who’s running for another Virginia Beach delegate seat, put it this way at a Saturday canvass launch: “Virginia has the chance to lead the nation again—to be the first state in the South to flip Democratic in modern times. We can join the 21st Century from the 19th!”

It’s encouraging that, despite all of the noise about impeachment and Trump’s distractions du jour, Democrats have kept a sustained focus on the most pivotal issue for millions of Americans — health security. That’s why next month’s elections could set the stage for a Democratic landslide in 2020.

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