"The group that says it is important is dominated by women and urban professionals and lower-socio economic and labor groups and their numbers are big," Keckley says. "They took most of these races. They helped the Democrats increase their Senate cohort. You are going to see more support and proactive selling of health reform over the next couple of years. Its profile will be substantially higher than it has been in the last year."
Keckley says the Supreme Court ruling on the Medicaid expansion "actually forces into this discussion of Medicaid the notion of some level of flexibility. Getting something done maybe better than nothing, but every state is going to negotiate a different deal."
Keckley sees "two dynamics" playing out in the Medicaid expansion talks, especially as they relate to the eligibility threshold of 138% of the federal poverty level for new enrollees.
"One is there is an expectation that (the Centers for Medicare and Medicaid Services) will negotiate with the states and perhaps there will be some concessions made around the 138% threshold, with some states maybe going up to 100%," he says.
"Because of the Supreme Court's ruling there is a lot of deal making that will be made between CMS and the states. People have pretty much set aside 16 million new enrollees, which was the original number. But the thought now is we might pick up between 9 million and 12 million."