Even as embattled Republican candidates across the country pledge to protect Americans with preexisting medical conditions, nearly all continue to resist extending health protections to their poorest constituents.
Republicans running for governor in states that have not expanded Medicaid to low-income adults through the Affordable Care Act almost universally oppose any coverage expansion through the government safety net program.
And in four states where voters will decide the fate of Medicaid expansion next week, the majority of Republican politicians have either remained silent or oppose the Medicaid ballot measures.
Facing a barrage of attacks from Democrats for voting to scrap the 2010 healthcare law, often called Obamacare, Republican candidates in recent weeks have insisted they, in fact, have championed protections for patients with preexisting conditions.
But the wall of GOP resistance to Medicaid coverage risks undercutting that effort as well as leaving millions of low-income Americans in states from Florida to Texas to Wyoming without access to health insurance or regular medical care until at least the next election.
Healthcare experts see Medicaid as the most practical way to protect low-income Americans with preexisting medical conditions, as these patients would not otherwise be able to afford insurance protections.
“Expanding Medicaid gives access to affordable coverage and care, regardless of health history,” said Elizabeth Carpenter, senior vice president at Avalere Health, a consulting firm based in Washington, D.C.
By opposing Medicaid protections, the GOP has also given Democrats a political weapon in a number of states with highly competitive governor’s races, including Florida and Georgia, where Democratic candidates have made Medicaid a key plank in their campaign platforms.
“We should be expanding Medicaid and making sure everyone with a preexisting condition has the coverage they need when they need it,” declared Andrew Gillum, the Democratic gubernatorial hopeful in Florida, where hundreds of thousands of uninsured people stand to gain coverage if the state expands Medicaid.
Florida’s current governor, Republican Rick Scott, has been an opponent of Medicaid expansion. Scott is now running for Senate.
Medicaid is also figuring in close gubernatorial elections in Kansas, South Dakota and Wisconsin, where incumbent Republican Gov. Scott Walker has been among the most ardent opponents of the 2010 law.
“[Medicaid] is a very strong issue, even in red states like Oklahoma and Montana,” said veteran Democratic pollster Celinda Lake, noting the program is viewed favorably by 60% to 65% of voters.
“That is more popular than almost all of the politicians who oppose it, even in red states,” she said.
Indeed, polling in the four red states where Medicaid expansion is on the ballot next week – Idaho, Montana, Nebraska and Utah – has shown solid public support for expansion, despite the resistance from GOP politicians.
The notable exception to that resistance is in Idaho, where the outgoing Republican governor, Butch Otter, this week announced his support for the Medicaid measure.
But Idaho Lt. Gov. Brad Little, the Republican running to replace Otter, has said there are better ways to help low-income patients without coverage, though he has not specified what those ways might be.
Nebraska Gov. Pete Ricketts, a Republican who has spent years fighting Medicaid expansion in his state, has not taken a position on the state’s Medicaid ballot measure this year as he runs for reelection.
There are no governor’s races in Utah or Montana, but the GOP Senate candidates in both states – Mitt Romney and Matt Rosendale, respectively – have opposed expanding the safety net program through the healthcare law.
Romney, who helped expand coverage as governor of Massachusetts, opposes the Medicaid ballot measure in Utah. And Rosendale, a former state legislator, voted against expanding Medicaid in Montana. The expansion there is set to sunset next year unless voters decide to extend it.
Medicaid, the half-century-old government health plan for the poor, is a pillar of the healthcare law's program for guaranteeing coverage and has helped drive a historic drop in the nation's uninsured rate.
The law makes hundreds of billions of federal dollars available to states to extend Medicaid coverage to poor adults, a population that had been largely excluded. Medicaid eligibility historically was limited to vulnerable populations, such as low-income children, pregnant women, the elderly and people with disabilities.
Most states moved to expand eligibility as soon as the healthcare law made additional federal aid available. To date, 33 states and the District of Columbia have elected to expand.
GOP opposition -- concentrated in the Deep South and the Great Plains -- has left about 2.2 million low-income Americans without insurance protections in the states that haven't expanded Medicaid, according to an analysis by the nonprofit Kaiser Family Foundation. Almost half of those uninsured people live in just two states, Florida and Texas.
Many Republicans have argued that the program is unaffordable and ineffective, though a growing body of research shows Medicaid significantly improves poor Americans' access to vital medical care.
Across the country, most GOP candidates continue to make this argument.
In Florida, former Rep. Ron DeSantis, who as a member of Congress voted repeatedly to repeal the 2010 health law, released a healthcare plan last week that he said would “protect access for patients with pre-existing conditions.”
At the same time, though, DeSantis said he continues to opposes Medicaid expansion, arguing that the program should not serve able-bodied adults. That is “not what Medicaid was designed for,” he said.
DeSantis’ heath plan does not specify how these people should be able to get health coverage, especially if they are ill or cannot afford a commercial health plan.