2. StateElectionUpdate
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3. StateElectionUpdate
Different Approaches to Healthcare
Current Administration Moderate Republicans
• Repeal ACA
• Shift control of Medicaid from
federal to state government
• Amend ACA and expand Medicaid
in order to address constituent
concerns
Centrist Democrats Progressive Democrats
• Support ACA
• Expand Medicaid
• Maintain coverage for pre-existing
conditions
• ACA insufficient
• Support government-run single
taxpayer system
References
Kaiser Family Foundation, New Republic
4. StateElectionUpdate
Major Policy Issues
• ACA coverage for those with pre-existing conditions
• Medicaid expansion
• Medicaid work requirements
• Prescription drug prices
• Home care services
• Nurse-patient staffing ratios
6. Current Status Quo
StateElectionUpdate
• 26 states are
Republican trifectas*
• 8 states are
Democratic trifectas
• 16 states have divided
governments
Party Control by State
*Nebraska’s legislature is officially nonpartisan and unicameral, but the majority of the Legislature’s members are Republican.
Reference
Governing
7. Gubernatorial Races
Election Forecast
• 36 races
• 9 states are tossups
• Predict Republicans will
win 18 races
• Predict Democrats will win
9 races
• Races in 36 states may have
implications for state
Medicaid
StateElectionUpdate
References
FiveThirtyEight, Governing, Governing, USA Today, Ballotpedia
8. StateElectionUpdate
State Legislature Races
Election Forecast – State Senate
• 42 races
• 4 states are tossups
• Predict Republican controlled
Senate in 25 states
• Predict Democratic controlled
Senate in 13 states
References
Governing, Ballotpedia
9. StateElectionUpdate
State Legislature Races
Election Forecast – State House of Representatives
• 45 races
• 1 state is a tossup
• Predict Republican
controlled House in 27 states
• Predict Democratic
controlled Senate in 17 states
References
Governing, Ballotpedia
11. Florida
StateElectionUpdate
Legislative Outlook &
Factors to Watch
• Republican trifecta
• Displaced Puerto Ricans who are US
citizens are a constituent to watch
• Close race for the House
References
FiveThirtyEight, Talking Points Memo, Florida Trend, UPI, Governing, Ballotpedia
Florida
Ron DeSantis
Former FL House Rep
Keep FL as one of the lowest tax
states in the nation.
RAndrew Gillum
Tallahassee Mayer
Medicare for All – Lower costs,
expand coverage, protect people
with pre-existing conditions.
D
12. StateElectionUpdate
Iowa
Legislative Outlook &
Factors to Watch
• Republican trifecta
• House to Democrats but Senate with
Republicans
References
FiveThirtyEight, Governing, Ballotpedia
Kim Reynolds
Incumbent
Supports Medicaid managed
care, needs more than 2 years to
succeed.
RFred Hubbell
Attorney
Opposes Medicaid managed care
and move away from it.
D
13. StateElectionUpdate
New Hampshire
Legislative Outlook &
Factors to Watch
• Currently Republican trifecta
• Very divided state
• Initially Legislature was a tossup, now
predicting Democratic control
References
Ballotpedia, FiveThirtyEight, Governing
Molly Kelly
Former NH Senator
Opposes work requirement and
supports ACA.
D Chris Sununu
Incumbent
Expanded Medicaid but
implemented work requirements.
R
14. StateElectionUpdate
Wisconsin
Legislative Outlook &
Factors to Watch
• Republican trifecta
• Democrats have flipped 2 seats in special
elections
• Assembly projected to stay Republican
References
FiveThirtyEight, Ballotpedia, Governing
Tony Evers
Educator
Expand Medicaid, stabilize
insurance markets, protect pre-
existing conditions.
Scott Walker
Incumbent
Implemented Health Care
Stability Plan and committed to
protect pre-existing conditions.
RD
18. StateElectionUpdate
Idaho
Supporters Critics
• A yes vote: In favor of expanding Medicaid
eligibility
• Two committees have raised $594,191
• A no vote: Against expanding Medicaid
eligibility
• Committee has raised $29,299
Proposition 2, Medicaid Expansion Initiative
Expand Medicaid coverage to those under 65 years old, whose income is 133% of the
federal poverty level or below, who are not eligible for other state insurance coverage
References
Idaho Statesman, Ballotpedia
19. StateElectionUpdate
Maine
Question 1, Payroll and Non-Wage Income Taxes for Home Care Program Initiative
Provide long-term healthcare and social services to adults 65+ or with physical or mental
disabilities in their homes at no cost, requires enacting a 3.8% income tax on residents who
earn $128,400+ per year
Supporters Critics
• A yes vote - Supports enacting a payroll tax
and non-wage income tax
• Long-term care crisis
• Two committees have raised $1.28 million
• A no vote - Opposes enacting a payroll tax
and a non-wage income tax
• Committee has raised $640,699
References
Governing, Ballotpedia
20. StateElectionUpdate
Massachusetts
Establishes patient assignment limits for nurses who work in hospitals, and limits must be
met without reducing staff from service, maintenance, or clerical positions
Supporters Critics
• A yes vote – supports patient assignment
limits
• Committee has raised $8.08 million
• October polling 47.5% approve
• A no vote – opposes patient assignment
limits
• Committee has raised $13.35 million
• October polling 45% oppose
Reference
Ballotpedia
Question 1, Nurse-Patient Assignment Limit Initiatives
21. StateElectionUpdate
Conclusions
• Expect a decrease in the number of Republican
trifectas
• Some Republican candidates are embracing
Democratic healthcare policy
• Changing voter expectations on healthcare
22. THANK YOU!
Elizabeth Tseng
Associate Consultant
Elizabeth.Tseng@FiscalNote.com
412-897-6001
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