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With GOP Losses, Obamacare Heads For Expansion And Calm

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After two years of Republican legislative attacks on the Affordable Care Act, the law providing individual coverage to more than 20 million Americans is about to enter a period of calm and expansion, healthcare executives and industry analysts say.

The 2016 election of Donald Trump and GOP control of both houses of Congress resurrected the idea that the ACA could be repealed and the Medicaid expansion rolled back or eliminated. That would have been a disaster for health insurance companies that placed big bets on the ACA like Centene, Molina Healthcare and startups like Oscar Health and Bright Health.

Instead, last Tuesday’s midterms gave Democrats control of the U.S. House of Representatives and winning ballot initiatives in three Republican-leaning states to expand Medicaid under the ACA. The prospect of bipartisan healthcare solutions and more than 250,000 newly insured Americans in Nebraska, Utah and Idaho where public ballot measures passed will be welcome for doctors, hospitals and insurers administering the benefits.

What’s more, the “repeal Obamacare” battle cry of Republicans has essentially died with several GOP conservatives failing to win governorships in Wisconsin and Kansas where outgoing Republican governors have stymied Medicaid expansion.

“I am hopeful that the most recent election –which did not give control of all three branches of government to one party—will ideally create an environment that requires a level of cooperation that fosters policies that are more inclusive of the population in general,” Centene chief executive Michael Neidorff said last week after the election. “The one thing these past elections at the state and federal level have shown is that there is tremendous bi-partisan support to provide high quality, efficient and affordable care to all Americans, including the poor and working poor. The elimination of pre-existing conditions from a policy is also very important to the greater public.”

Exit polling in several key races showed healthcare was a top issue for voters, particularly in races where Republicans were defeated like Nevada’s U.S. Senate race where Jacky Rosen beat Dean Heller and in Congressional races across the country that awarded Democrats control of the U.S. House.

Take Cindy Axne, who won Iowa’s Third Congressional District defeating Republican incumbent Dave Young, an ACA opponent and one-time staffer and protégé of the 85-year-old U.S. Senator Chuck Grassley (R-Iowa).

“It has been a cornerstone of our campaign,” Axne said of healthcare and saving the Affordable Care Act during a conference call last week with reporters held by the group Protect Our Care.

“One of the first things I did was hold a healthcare forum” when she began her race, Axne said. In the summer of 2017, Iowans in her district and other parts of the state supported Obamacare by 20 points or more just after Republicans had made aggressive attempts to repeal the law.

Times have changed. Axne now says her work in Congress will involve “shoring up” the law to make it work better for Americans including Iowans her district.

Industry analysts like Ana Gupte at Leerink Partners called a Democratic takeover of the U.S. House and Democratic wins of governorships a “purple scenario” that would benefit Medicaid expansion.

In states like Wisconsin, defeated Republican Gov. Scott Walker has balked at providing additional health benefits in his state. Wisconsin is the only state in the Upper Midwest that hasn’t expanded Medicaid with Iowa, Illinois, Minnesota, Michigan, Indiana and Ohio all having expanded health insurance for poor Americans in a bipartisan fashion in some cases.

For health insurance companies like Aetna, Anthem, Centene, Molina Healthcare and UnitedHealth Group, Medicaid expansion will have growth opportunities, particular in states that have moved from fee-for-service Medicaid to private managed-care as most have.

“2019 will see additional opportunities for Centene, with the current administration poised to give states more flexibility to design Medicaid programs and provide Marketplace reforms that meet the needs of their constituents,” Centene’s Niedorff said. This aligns well with Centene’s decentralized operating model and plans for future growth.”

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