Health care access appears to have played a big role in elections last week

northam-300x228Millions of Americans may qualify for federal help in paying for the health insurance, but they must sign up for coverages on exchanges set up under the Affordable Care Act, aka Obamacare, by Dec. 15. Doing so, starting with a visit to, has become a surprisingly popular and perhaps a strongly political act.

That’s at least one way to look at it after voters, led by Virginians, sent a big electoral rebuke to President Trump and congressional Republicans over their failed congressional assault and continuing efforts to repeal and replace the ACA, especially its increasingly popular expansion of Medicaid. Its programs benefit the poor, young, old, chronically and mentally ill—and growing numbers of working poor and middle-class Americans, too.

The punditry has flowed since Tuesday’s elections in Virginia, New Jersey, Maine, and elsewhere. Virginia voters not only trashed Ed Gillespie, the Republican candidate who was supported by Trump, and elected Ralph Northam, a Democrat, a pediatrician, and a veteran who was the state’s lieutenant governor (see photo), they also churned the membership of the state legislature. Control of the House is up to recounts in a few tight races.

But, based on exit polling, voters spoke loudly, saying their chief concern when they cast their ballots focused on health care. If, and this is still a big if, the legislature in Richmond changes political hands, Northam may be able to push Virginia into joining 33 states (including Maryland and the District of Columbia) that expanded the Medicaid program under provisions of the ACA. That could mean more than 600,000 Virginians could receive some form of health coverage and new and more medical care.

They also would be part of a program that may have just added 70,000 residents of Maine. Voters there  approved a ballot measure calling for an ACA Medicaid expansion—an initiative that Maine’s governor has vetoed multiple times. 

Even before Maine settles its Medicaid tussles, however, advocates in other states may try to follow with ballot initiatives to bypass governors who have opposed expansion of the federal program in their states. Eighteen states have not adopted the ACA Medicaid expansion, and the New York Times says Tuesday’s election results may encourage or push even further efforts by program advocates in Idaho, Utah, Kansas, and North Carolina.

It’s clear why both the ACA and Medicaid, especially, are enjoying a popularity surge after seven years of brutal GOP assaults. In my practice, I see not only the significant harms that patients suffer while seeking medical services but also their giant struggles to afford accessible medical care. Though GOP partisans recoil at any government role in health care, Americans increasingly are coming around to the view that it is not a privilege but a right—and to make it safer, more affordable and accessible, and high quality we need to share better its costs, risks, and rewards.

In contrast, Republicans have shown their willingness to savage the poor, working poor, and middle-class Americans, and especially their access to health care, so the party can shower tax cuts and other benefits on the wealthy and huge corporations.

The Trump Administration and the GOP have further reinforced their harsh positions about those most in need and what they might expect from Uncle Sam. Although evidence shows most Medicaid recipients cannot work—because, for example,they are too sick, too young, too old, or are taking care of others in worse shape than them—the head of the agency that oversees Medicaid and Medicare keeps insisting that states should be allowed to compel program recipients to try to get jobs, and, no matter the difficulties it may cause them, to make them re-up for any benefits often and get them for shorter periods.

They, at least, won’t be expected to subsist on cake.

Who knows, however, what shambles the partisans will make of not just the nation’s safety net programs but of all medical services after they rumble through a poorly disclosed, barely discussed, little supported, and hastily pushed plan to change the tax code? The prospective tax changes, along with a budget plan to pay for big tax cuts for corporations and the wealthiest elites, may gut Medicaid, Medicare, and a vast array of medical, scientific, and public health programs.

Just to be clear, federal programs need rigorous oversight and cost-smart innovations should be welcome. In California, where state officials embraced the ACA and the Medicaid expansion, there’s a huge, needed re-examination under way as to whether the Golden State got too generous with insurers, allowing them big and underserved profits, also without equivalent gains in quality coverage, from their part in the state’s Medi-Cal program. There may not be claw-backs, but state officials promise, at minimum, to pound on insurer rates and services going forward, now that all the parties involved have experience and data with a program that now covers 1 in 3 Californians.

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