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The future of Obamacare’s Medicaid expansion was thrown off track in two key states after Tuesday’s elections, but it could make a comeback in a third state in a few weeks.

In Kentucky and Virginia, Tuesday’s results can be seen as nothing less than a loss for this key provision of the Affordable Care Act, which seeks to extend government health coverage to low-income people. Republican Matt Bevin won the Kentucky governorship, and Republicans held onto the Virginia state senate.

In Louisiana, however, there’s still a chance that the upcoming gubernatorial runoff could clear the way for Medicaid expansion in a state that has resisted it for years.

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Here’s what you need to know.

Kentucky

Kentucky has been one of the health care law’s success stories under Democratic Governor Steve Beshear. The state had a successful rollout of its own health insurance marketplace and has signed more than 400,000 people for expanded Medicaid.

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But Bevin’s victory over outgoing Democratic Attorney General Jack Conway puts its future in doubt. Bevin, who launched a failed insurgent conservative primary challenge to Senate Majority Leader Mitch McConnell last year, railed against Obamacare and Medicaid expansion in his campaign.

“Absolutely. No question about it. I would reverse that immediately,” Bevin said in February, according to the Associated Press.

But in the latter stages of the campaign, he became a little less absolutist. Bevin said during a debate that he would apply for a federal waiver to mold the program more to his liking, as some other Republican-led states have done in exchange for expanding eligibility under the health care law.

A Bevin spokesman told the Courier-Journal that the now-governor-elect wants to “repeal” Medicaid expansion, while applying for a federal waiver “in order to better customize a solution to address the health care needs of the Commonwealth.”

Some states, like Arkansas and Iowa, have successfully negotiated with the Obama administration to implement alternate expansion programs. But others, such as Utah, have failed to come to an agreement with the feds. The details of the waiver that Bevin says he will propose will be watched closely.

Virginia

Governor Terry McAuliffe and the Republican-controlled legislature have been at loggerheads over Medicaid expansion, which would cover as many as 400,000 people in Virginia, for more than a year.

McAuliffe, a Democrat, campaigned in favor of expansion in 2013, but conservatives in the state Capitol have refused to budge. The House rejected a Senate-supported plan for privatized expansion, and a stalemate has persisted since.

McAuliffe campaigned for Democrats this year in part on the message that giving his party control of the Senate would give him the necessary leverage to implement his agenda, including Medicaid expansion.

“If I have one chamber to work with, it might be a little easier to get some of this done,” he said in the last days of the campaign, per the Washington Post. “It is hard when they won’t even sit and talk to me about how to expand Medicaid, won’t even talk to me about pre-K. I can’t negotiate against myself.”

But on Tuesday, Republicans maintained their 21-19 majority in the Senate, a likely indication that the impasse is here to stay.

Louisiana

Because of Louisiana’s unusual election format, ballots will be cast on Nov. 21 in the gubernatorial race between Republican US Senator David Vitter and Democratic state Representative John Bel Edwards. Recent polls show Edwards leading Vitter by double-digit margins.

Outgoing Governor Bobby Jindal, who’s now running for the Republican presidential nomination, has steadfastly refused to expand Medicaid, which would cover about 200,000 people in the state. But Vitter has signaled a willingness to consider it, according to The Advocate in Baton Rouge. He says he won’t take it “off the table, but in order for that to be a responsible option, I think we need to make sure of several things.”

One of Vitter’s conditions would be to require hospitals to contribute toward the state’s match to pay for expanded coverage, the newspaper reported. But Vitter has also floated some kind of work requirement, per the Times-Picayune, which the Obama administration has said is a non-starter in Medicaid expansion negotiations.

Edwards, less surprisingly as a Democrat, has said that he would expand Medicaid his first day in office.

  • I pray Trump doesn’t cut all expansion of Medicaid/medical program, I work 2 jobs, I was in a life changing accident 3 years ago without Obama care medical expansion I’d properly be dead I cant afford the heart medication or medical coverage to get INR blood test every month cause I’m on a blood thinner for the rest of my life, I can barely afford rent and food, I only receive assistance with medical no other assistance, I pray he cares about low income working Americans, just because we are poor, don’t mean we don’t work for every penny, I pay taxes why shouldn’t I be eligible for medical, the government pays for so many cost to assist other country why not United States.

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