Democrats in crucial battleground and Republican-leaning states are hammering their GOP opponents for opposing expanding Medicaid to more residents in those states, a sign of how firmly the party has seized the political advantage on health care a decade after the passage of Obamacare.
Democrats in Senate races in North Carolina, Colorado, Kansas, Montana and Alabama all plan to make their support of Medicaid expansion a central part of their campaigns. And though there are relatively few competitive governor’s races likely in 2020, the issue is expected to play a major role in contests in North Carolina and Missouri.
Even before the coronavirus pandemic infected nearly 5 million Americans, public polling showed voters across the country continued to say health care was the most important issue in the 2020 election and showed they continued to trust Democrats more than Republicans to handle the issue.
And the policy has proved to be popular even in red states: Voters have approved Medicaid expansion in referendums in the solidly Republican states of Utah, Idaho, Nebraska and Oklahoma.
The issue is now at center stage in Missouri, where voters on Tuesday will decide whether the state should expand Medicaid in a referendum. Like in the other 38 states that have expanded coverage as part of the Affordable Care Act, adults making up to 133% of the federal poverty level, about $16,612 annually for an individual, would qualify for the program, with the federal government picking up 90% of the tab. That could mean 460,000 additional Missourians would qualify for Medicaid.
Auditor Nicole Galloway, the Democrat challenging GOP Gov. Mike Parson, said she was confident Missourians would vote yes on Tuesday’s referendum, which Republicans intentionally scheduled for a lower-turnout primary day instead of for November’s general election.
“He has no plan. He has no vision. He’s not talking about health care,” Galloway said of Parson in a phone interview. “He’s not trying to address this with any policy proposal. The contrast could not be more stark.”
In recent days, the 37-year-old Galloway has based almost her entire campaign on support for Medicaid expansion. She’s held virtual events with the doctor who started the petition drive that led to Tuesday’s referendum, with the St. Louis chapter of the NAACP and with a state House candidate who lost his Medicaid coverage during Parson’s administration.
Missouri has a recent history of adopting liberal policy positions through referendums only to then defeat the Democratic candidates who support those ideas at the ballot box. In 2018, voters overturned the state’s right-to-work law by a two-thirds margin in August, then ousted Democratic Sen. Claire McCaskill in November.
Galloway said this year will be different because voters won’t trust Parson to implement the law. She noted that Republicans in recent years have undermined voter-passed initiatives to end gerrymandering, and Parson himself was the lead author of legislation that overturned a state ban on puppy mills put in place by voters in 2010.
“He cannot be trusted to implement Medicaid expansion,” she said. “We can let history be our guide here.”
Parson’s reelection campaign did not respond to a request for comment. Public polling of the race between him and Galloway has generally given the Republican a small lead, but his handling of the coronavirus pandemic has come under increasing scrutiny in recent weeks.
Trump won Missouri by 19 percentage points in 2016, but some Democrats believe former Vice President Joe Biden can keep the race close enough to give Galloway a shot at victory.
In North Carolina, where Gov. Roy Cooper is favored to win reelection and Cal Cunningham is in a toss-up race with GOP Sen. Thom Tillis, both Democrats plan on hammering their opponents over Republicans’ long-standing opposition.
“When Thom Tillis had the chance to expand Medicaid to get more people health care coverage,” a narrator says in an ad from Majority Forward, a Democratic nonprofit group, attacking Tillis, “he voted no, leaving half a million North Carolinians without care.”
In Montana, Gov. Steve Bullock, who is challenging GOP Sen. Steve Daines, is airing ads highlighting how his willingness to work with GOP legislators to pass Medicaid expansion has helped keep the state’s rural hospitals open and prove his bipartisan credentials.
“Washington plays politics with your health care, but Bullock does what’s right for Montana,” the narrator says in the 30-second spot.
And Sen. Doug Jones of Alabama, likely the most vulnerable Democratic incumbent in the country, has introduced legislation that would have the federal government fully reimburse states for the cost of the expansion for three years. Jones and Sen. Mark Warner (D-Va.) tried to pass the legislation via unanimous consent in the Senate last week but were denied.
“We haven’t expanded Medicaid, for political reasons,” a frustrated Jones said of Alabama in a phone interview last week. “No one wanted to legitimize Obamacare.”
This article originally appeared on HuffPost and has been updated.