Three of the 12 states that are holding governors’ races have not expanded Medicaid-Missouri, North Carolina, and Utah. Regardless of whether Democrats win those races, newly elected governors could pursue Medicaid expansion. If all three of these states were to expand, approximately 1.2 million individuals could be newly covered by Medicaid. To date, 31 states and Washington, D.C. have expanded Medicaid under the Affordable Care Act.

“Not surprisingly, most people have focused on the 2016 races at the federal level, but what happens in the states really matters,” said Elizabeth Carpenter, senior vice president at Avalere. “In particular, new governors may reconsider state decisions to expand Medicaid or rethink the approach to expansion.”

Beginning in 2017, states will need to contribute to the cost of coverage for newly eligible Medicaid enrollees. While this financial burden or election outcomes could cause some states to rethink their expansion decisions, Avalere experts say removing coverage from people who are benefiting from insurance is extremely politically challenging.

Separate from the elections, states will continue to consider their Medicaid expansion decisions. Nationwide, Missouri and Virginia are the only states with Democratic governors that have not expanded Medicaid. If these two states decided to expand coverage, a combined 745,000 people could be enrolled in 2017.

The remaining 17 states that have not expanded into Medicaid are led by Republican governors. If all of these states were to expand, almost 7 million additional individuals would have Medicaid coverage.

“Additional states expanding Medicaid would benefit hospitals and health plans,” said Caroline Pearson, senior vice president at Avalere. “Hospitals have seen increased volumes and lower rates of uncompensated care in Medicaid expansion states. Health plans would benefit from higher enrollment, since Medicaid has been the leading source of coverage for previously uninsured individuals.”

METHODOLOGY

Election outlook is based on polling data reported by the University of Virginia Center for Politics “Sabato’s Crystal Ball” as of October 26, 2016. Estimates of expected Medicaid enrollees assumes non-expansion states expand coverage under the Affordable Care Act in 2017 based on Avalere’s proprietary Health Insurance Enrollment Model. All enrollment numbers exclude dual eligible beneficiaries.