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Analysis

Healthcare Winners and Losers from Election Night 2018

By Jack O'Brien  
   November 07, 2018

The most significant developments of the night focused around Medicaid expansion, how healthcare leaders who ran for public office fared in the elections, and several down-ballot healthcare initiatives.

The 2018 midterm elections are over but made a significant impact on healthcare policies at the federal and state level across the country, while also determining who will be in office to enact them.

The future of healthcare policymaking will be influenced by the decisions made by millions of voters on Tuesday night, as Democrats took back the House while Republicans held onto control in the Senate. 

Healthcare was a top priority for voters as they made their way to the polls to vote on issues such as Medicaid expansion and the healthcare leaders seeking to represent them on Capitol Hill.  

Below are some of the most significant healthcare-related developments from the 2018 midterms:

Medicaid expansion approved in 3 red states, defeated in Montana

Three traditionally conservative states joined Maine in approving Medicaid expansion via ballot initiative, while voters in Montana sank the measure which was attached to a proposed tobacco tax hike proposal. 

More than 300,000 residents across Nebraska, Idaho, and Utah are likely to receive extended Medicaid coverage as a result of expansion. The number of places with Medicaid expansion now totals 37 states as well as the District of Columbia.

Support for the measure exceeded 60% in Idaho, while Utah and Nebraska approved Medicaid expansion with 54% and 53% of the vote, respectively.   

Montana, voting on the most expensive ballot measure in state history, voted down the expansion proposal, which will sunset at the end of the year.

(- Jack O'Brien)

Nurse staffing ratio proposal shot down in Mass.

Last night, Massachusetts voters had their say on ballot Question 1, which sought to implement nurse- to-patient ratios in hospitals and other healthcare settings.

It was met with a resounding 'no' from the electorate, with about 70% voting against the measure and almost 30% voting for it.

For months, the law has been hotly debated. Those in favor said it would improve patient safety and care. Those opposed said it didn't account for patient acuity and would create a financial burden on hospitals and healthcare systems.

Had the law passed, Massachusetts would have joined California as the only other state to require that level of mandatory ratios.  

(- Jennifer Thew, RN)

PROPONENTS OF MEDICAID WORK REQUIREMENTS

As expected, two of the three governors who received federal approval for Medicaid work requirements and were on the ballot for the midterms, Gov. Chris Sununu, R-N.H. and Gov. Asa Hutchinson, R-Ark., cruised to election night victories. 

Sununu defeated Democratic challenger Molly Kelly by a 52% to 46% margin while Hutchinson dispatched Democratic opponent Jared Henderson with 65% of the vote. 

The most vulnerable of the three Republican incumbents, Wisconsin Gov. Scott Walker, was unseated by Democratic opponent Tony Evers by just over a single percentage point.

Wisconsin had just received CMS approval for its Medicaid work requirements last week, which was the latest development in a race dominated by healthcare issues that ultimately pushed Walker out of office. 

(- Jack O'Brien)

Additional Healthcare ballot initiatives yield mixed results

Oklahoma voters rejected the Walmart-backed Question 793, which would have amended the Oklahoma Constitution to give optometrists and opticians the right to practice in retail stores. Walmart gave nearly $1 million in the third quarter alone to proponents of the initiative, which was narrowly defeated by less than 6,000 votes.

Nevada voters approve exemption of durable medical goods from state sales tax. Local media in Nevada are reporting that more than 67% of voters in state voted for Question 4, which amends the Nevada Constitution to require the state legislature to exempt some durable medical goods, including oxygen delivery equipment and prescription mobility-enhancing equipment, from sales tax.

California voters roundly rejected an initiative to cap the profits of kidney dialysis providers at 15% above direct patient cost. However, Golden State voters approved a ballot initiative that authorizes $1.5 billion in bonds to fund capital improvements at the state's 13 children's hospitals.

(- John Commins)

Bittersweet night for vulnerable House Republicans and Medicare for All proponents

The race in Kentucky's 6th Congressional District set the tone for the night among House races, as Rep. Andy Barr, who was targeted by Democrats for his support of House GOP plans to repeal-and-replace the ACA, faced Democratic challenger Amy McGrath, who voiced support in Medicare-for-All legislation.

A neck-and-neck race throughout the early part of the evening, Barr ultimately defeated McGrath, but other vulnerable House Republicans did not fare as well. 

In New York, Rep. John Faso lost to Democratic challenger Antonio Delgado in the 19th Congressional District, a race highlighted by disagreements over healthcare policy, and Rep. Claudia Tenney, a vocal critic of the ACA, was unseated by Democratic opponent Anthony Brindisi in the 22nd Congressional District.

Sen. Bernie Sanders, I-VT, and Rep. Pramila Jayapal, D-Wash., two of the most notable proponents of Medicare for All were reelected, while newcomer Alexandria Ocasio-Cortz, a self-described Democratic Socialist, became the youngest woman ever elected to Congress in New York's 14th Congressional District.  

However, other Medicare for All proponents did not perform as expected across the country, with Tallahassee Mayor Andrew Gillum losing a tight gubernatorial race in Florida to Republican Rep. Ron DeSantis, and Rep. Beto O'Rourke falling to Republican incumbent Sen. Ted Cruz in the Texas Senate race. 

(- Jack O'Brien)

HEALTHCARE LEADERS ON THE BALLOT

After a lengthy primary season and contentious general election cycle, numerous healthcare leaders won their respective elections Tuesday night.

Healthcare was one of the most prominent issues concerning voters in the midterm election cycle, punctuated by more than 60 declared candidates with healthcare backgrounds running for public office in 2018.

Around 35 candidates made it to the general election ballot and more than two dozen received a stamp of approval from the voters.

Most notably were Gov. Rick Scott, former head of Columbia/HCA, who won a neck-and-neck race against Sen. Bill Nelson, D-Fla., Lauren Underwood, RN, a former HHS adviser under former President Barack Obama, who defeated Rep. Randy Hultgren, R-Illi., and former HHS Secretary Donna Shalala, who won a hotly contested campaign in Miami.

(- Jack O'Brien)

Jack O'Brien is the finance editor at HealthLeaders. 


KEY TAKEAWAYS

Healthcare leaders who were elected: Gov. Rick Scott, Lauren Underwood, RN, and former HHS Secretary Donna Shalala.

Races where healthcare was a major factor: mixed bag for vulnerable House Republicans who voted to repeal-and-replace the ACA, as well as Medicare for All proponents.

Healthcare ballot initiatives: Three states approve Medicaid expansion, one does not; Massachusetts votes down Question 1.


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