Health care reform

State Level Elections Could Affect ObamaCare


President Obama's reelection dashed hopes for a repeal of ObamaCare in the near future. Now the focus turns to implementation, much of which will happen at the state level. And that means that governors will be the deciders.

At this point, governors face two key choices: whether to set up a state-run health insurance exchange, and whether or not to join in the law's Medicaid expansion. Kaiser Health News provides a useful rundown of how Tuesday's gubernatorial elections might affect some of those decisions:

Tuesday of Mike Pence, a Republican, who has said he opposes starting a state-based exchange. He also  favors expanding Medicaid only if the state can limit benefits and ask recipients to pay higher premiums. The state's outgoing GOP governor, Mitch Daniels, left the issues for his successor to decide.

In North Carolina, the election of Republican Pat McCrory  means that state is unlikely to expand Medicaid. McCrory has said he opposes the law, including  the Medicaid expansion . His Democratic opponent Walter Dalton favored the health law. The state's outgoing governor, Bev Purdue, a Democrat, left the decision to her successor.

Democrat Steve Bullock,  who is leading in Montana's gubernatorial race, is undecided on the Medicaid expansion and the creation of an insurance exchange. His Republican challenger, Rick Hill, said he was open to establishing the exchange but opposed a Medicaid expansion. Outgoing Gov. Brian Schweitzer was undecided on the issue.

Republican Gov. Gary Herbert of Utah, who was re-elected, opposes expanding Medicaid. His state has an insurance exchange dating back to 2008 and has been working to make changes to comply with the federal law.

Republican  Gov. Jack Dalrymple of North Dakota, who was also re-elected, has not taken a position on Medicaid expansion and has opposed  a state exchange

Several winners have yet to declare a position on implementing the health law, including Democrat Jay Nixon who won re-election as Missouri  governor.

When ObamaCare was passed, the assumption was that all states, even those controlled by Republicans, would create their own exchanges and expand Medicaid. But the Supreme Court's ObamaCare ruling let states opt out of the Medicaid expansion, and it turns out that states have a slew of incentives to avoid creating exchanges. Given the forces aligned against state participation, it's at least possible that half or more of the states will opt out of some major part of the law. With the deadline for states to declare their intentions to either set up exchanges or not coming before the end of the month, we'll soon have a clearer idea of just how many states are willing to participate.