Today will not only be the most pivotal Presidential election in decades, but in some ways could be just as important for some at the state level. Most people know that if Obama wins, plans of enacting the Affordable Care Act go on uninterrupted in 2014. What many people actually do not realize, is that the choice that some states have to fill their gubernatorial seats and legislative positions will also have important consequence. As the race for President nears an exhaustive end, there is still no clear front-runner. Whether Obama is victorious or Romney wins–and in the case that he may not be able to deliver a repeal in time for states to ignore legally mandated deadlines to file health insurance exchanges– states must decide whether to expand Medicaid health insurance and set up their own health insurance exchanges or opt out.
The 2010 Affordable Care Act was designed to overhaul the current health care system in the United States–which most experts agree needed some sort of reform—and it calls for states per a Supreme Court decision to choose to set up insurance exchanges. If state opts in, for those who do not have employer coverage or through government programs–they can then buy into some plan. And it also provides for government subsidies in some case if they need them. The state has the right to vote for the exchange and Medicaid expansion or opt out. Again, if voters are not completely aware of how the Affordable Care Act and its ramifications impact them at the state level, it could be monumental in terms of the vote and its affect on state run exchanges. The same holds true if they are aware of the state-run insurance exchange issue in terms of what party they choose for their legislators.
“One thing the voters should be aware of is what are their governors are going to be doing. Will more people have access to Medicaid or access to a state-run exchange?” says John Poelman of healthcare consulting firm Leavitt Partners and a former health policy analyst at the Department of Health and Human Services.
Two states which show the extreme polarization of this issue are Texas and Vermont. Texas Governor Rick Perry—who incidentally ran against Obama—vehemently opposes ‘socialized’ health care.
“We’re just not going to be a part of … socializing health care in the state of Texas,” Perry told reporters in July.
Perry supports a free market approach to care when it comes to insurance coverage.
Vermont Governor Peter Shumlin, however, believes in government funded care and providing care for everyone in the state. But it remains to be seen if that paradigm will hold up when the voters speak on Nov. 6.
Republicans are likely to dominate in Texas. In Vermont, Shumlin’s Republican opponent, Randy Brock, says single-payer health care is too costly. Vermont’s legislature will address the question of how to pay for this in January, with options including a capital gains tax or a tax on employers.
“They can disrupt implementation of the law. Leadership can either be aggressively moving it forward or impeding it,” Poelman says.
One Vermont resident, Anna Gebhardt, is hoping the state run exchanges continue. Her family is without insurance because neither she nor her husband have employer covered health care. Recently, Gebhardt was quoted in an article by Maggie Fox of NBC News, saying, “We are constantly at the whim of decisions being made by people who don’t depend on those services and don’t realize how their decisions affect people. We are constantly in limbo. We could create a system where efficiency works for the people and for the budget. That is where Vermont can lead the way.”
As we approach the final hours of this grueling Presidential race, two tired candidates wait for Americans to speak and two of the biggest provisions of the law — Medicaid expansion and setting up the health exchanges – teeter on the brink of implementation or dissolution. It is interesting how this will affect Obama support moving forward. However it’s more than interesting but downright messy if states overwhelmingly decide to uphold the exchanges–a Democratic supported stance–if Romney wins. How could this affect all of Romney’s plans for repealing the ACA legislation going forward if he is indeed our next president?