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Elex Reax: What the 2018 elections mean for health care

tl,dr: Yesterday was a huge victory for high quality, affordable health care in election after election.

In exit polls nationwide, voters confirmed that health care was their top priority—and they punished those officials at every level of government who had sought to take it away. Even in races where health care proponents ultimately lost, the margin of victory was often significantly closer than anyone would have predicted two years ago in states won handily by Donald Trump—thanks to the power of health care voters. And, of course, a number of the Affordable Care Act’s harshest foes were forced to lie about their opposition to the law in a sweeping reversal of health care politics from previous election cycles.

With Democrats taking control of the U.S. House of Representatives, the door has been firmly closed on further legislative attempts next year to repeal the ACA, gut Medicaid, block low-income patients from accessing care at Planned Parenthood, or cut Medicare to pay for the GOP tax cuts. The change in power also has significant implications for the kinds of oversight that the House will conduct. House committees are now expected to investigate the administration’s efforts to sabotage the ACA and its refusal to defend the law in court. We may even get the full investigation of Brett Kavanaugh in the House Judiciary Committee next year that the Senate Judiciary Committee refused to conduct this year.

The next two years could be particularly turbulent for House Republicans, two-thirds of whom have never served in the minority before. We can look to a recent analog in the 2006 wave elections, where a similarly long-standing Republican majority was handed defeat. Chafing in the minority and facing another tough re-election fight defined by an unpopular president, large numbers of Republicans who’d survived 2006 announced their retirement. How this could affect a smaller, Trumpier GOP conference’s approach to health care, we’ll have to wait and see.

In the Senate, where Democrats were defending ten seats in states won by Trump, Republicans only increased their narrow majority by 2 to 4 seats. We may not know the outcome of races in Arizona and Florida until next week. The loss of the House neuters Senate Republicans’ ability to pass harmful legislation but the additional seats gives them a larger buffer to confirm extremist conservative judges. And in fact, Mitch McConnell is expected to spend the next two years aggressively attempting to remake the federal judiciary in Trump’s image. As disturbing a prospect as this is, however, it’s still a marked reversal in fortunes from the filibuster-proof majority that Republicans had once envisioned for 2019.

In Nebraska, Idaho, and Utah, voters overwhelmingly passed Medicaid expansions by ballot initiative, closing the coverage gap for 300,000 people. Our early sense from all three states is that none of their Republican governors are likely to follow the lead of Maine’s departing governor, Paul LePage (R), who has been illegally blocking a voter-approved expansion this year.

In Kansas and Maine, voters elected pro-health care governors, easing the path for Medicaid expansion. Both states had previously passed Medicaid expansions through their Republican-controlled legislatures only to see extremist governors veto them. Pro-expansion gubernatorial candidates also won in states like Wisconsin (with a partial expansion) and Michigan (which had sought to undermine its expansion through the waiver process). And in Georgia, where Republicans engaged in blatantly illegal efforts to suppress the African American vote, pro-expansion candidate Stacey Abrams could be headed to a run-off election depending on the outcome of a recount.

In Nevada and New Mexico, newly elected state leaders are considering Medicaid buy-in programs to allow residents with incomes above the threshold for Medicaid eligibility to use their ACA assistance to purchase Medicaid coverage instead of a private plan. Nevada’s legislature passed Medicaid buy-in in 2017 but the program was vetoed by outgoing Governor Brian Sandoval (R); in contrast, incoming Governor Steve Sisolak (D) is supportive.

But even as we celebrate our health care victories—and mourn the loss of some great health care champions—we know our work is far from over. In Texas, one of the most openly partisan judges on the federal bench is set to rule very soon against the ACA's consumer protections, including those for people with pre-existing conditions. And the Trump administration is rushing full speed ahead to sabotage ACA marketplaces and push "junk" plans on unsuspecting consumers.

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