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Avalere Analysis: Reactions to the 2014 Midterm Elections

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The following is a list of Avalere Health analyses and reactions to Tuesday's midterm elections.

Governor’s Races & Medicaid

Avalere expects little immediate change in terms of state Medicaid expansion decisions. Incumbent Republican governors were reelected in non-expansion states such as Florida, Georgia, Maine and Kansas, suggesting that those states are unlikely to pursue Medicaid expansion.

In Wisconsin, Gov. Walker (Rep.) was reelected; Avalere expects him to stick with his initial approach to cover individuals under the poverty line through a non-ACA Medicaid waiver.

There are three states that have already expanded Medicaid that bear watching moving forward.

    In Arkansas, Governor-elect Hutchinson (Rep.) has stated that he views the Private Option as a pilot project; however, he has also indicated that he may consider alterations and / or ending the program altogether. The program requires legislative approval for funding annually, and previous votes have been challenging. Some form of coverage expansion is likely to continue, though programmatic revisions will be debated heavily.

    In Pennsylvania, Governor-elect Wolf (Dem.) campaigned on his desire to abandon the state’s Medicaid waiver expansion (“Healthy PA”) in favor of a traditional Medicaid expansion. Given that Healthy PA is set to begin enrollment in January, immediate changes are unlikely, but the incoming Governor could examine potential changes to the waiver program upon taking office.
    In Illinois, Governor-elect Rauner (Rep.) made clear during his campaign that he would have vetoed the state-legislature-passed Medicaid expansion, but that he would abide by it if elected. It will bear watching to see if he attempts to alter the program in any way.


As of Wednesday morning, Republicans had taken control of the Senate with 52 votes, and had also picked up seats in the House where they claimed 242 votes. There are several races that have not yet been resolved.

Avalere expects significant Congressional attention on the Affordable Care Act during the next Congress. While Republicans do not have the votes to override a Presidential veto, they will be able to pursue targeted amendments to the Act. These amendments could include repealing the politically-vulnerable provisions such as the individual and employer mandates, the health insurer tax, the medical device tax and the Independent Payment Advisory Board. Some of these issues, particularly modifications or delays to the employer mandate, could secure the bipartisan support needed to overcome a veto.

That said, Avalere believes that the Affordable Care Act is here to stay. By the time that a new President takes office in 2017, Avalere projects that 24 million people will be enrolled in exchanges and another 13 million in Medicaid as a result of the law – making repeal politically challenging and unlikely. But given that the 2016 election will take place with several years of experience in the successes and failures of the ACA, Avalere expects the 2016 elections to include visions from both parties for how they would alter the law.

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