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Insight: Are the politics of Obamacare changing in the South?

Cracks are starting to show in the wall of Southern opposition to Medicaid expansion

♦By Rich Shumate, ChickenFriedPolitics.com editor

After Obamacare made its way through Congress in 2009, triggering the Tea Party rebellion, Republican-controlled Southern statehouses became a redoubt of opposition to what critics saw as meddlesome socialist overreach.

ChickenFriedPolitics editor Rich Shumate

When, three years later, the U.S. Supreme Court ruled that the Obama administration couldn’t force states to enact a key Obamacare provision — expanding Medicaid to cover more low-income residents — most Southern states took advantage of the decision and didn’t.

Today, nine of the 14 states that haven’t expanded Medicaid are in the South, leaving more than 2.3 million low-income Southerners who would qualify for Medicaid without health care coverage, according to researchers at the Kaiser Family Foundation.

But there are some signs that the blanket opposition to expanding Medicaid in the South may be retreating, albeit slightly and slowly.

Louisiana and Virginia expanded Medicaid after electing Democratic governors in 2017. In Arkansas and Kentucky, where expansion passed under Democratic governors, it has endured despite their replacement by more skeptical Republicans.

In Florida and Oklahoma, petition drives are underway to put expansion on the ballot in 2020, doing an end-run around recalcitrant GOP leaders. And in Mississippi, a Democrat is trying to use expansion as a wedge issue to end a 16-year Republican lock on the governor’s office.

In states with expanded Medicaid, low-income people making up to 138 percent of the federal poverty level — about $17,000 for an individual — can get coverage. In states without expansion, the income limit for a family of three is just under $9,000; single people are excluded entirely.

Most of the singles and families who are not eligible for traditional Medicaid don’t make enough money to get the tax credits they need to buy insurance on the Obamacare insurance exchanges. According to estimates from Kaiser, 92 percent of all Americans who fall into this coverage gap live in Southern states that haven’t expanded Medicaid, including nearly 800,000 people in Texas, 450,000 in Florida, 275,000 in Georgia, and 225,000 in North Carolina.

The federal government pays 90 percent of the cost of Medicaid expansion; states must pick up the rest. Republican leaders who oppose the idea have balked at making a financial commitment to such an open-ended entitlement, which Congress could change at any time.

But that argument didn’t hold in Virginia after Democrats campaigning on expansion nearly took control of the legislature in 2017. When expansion came up for a vote, 18 House Republicans who survived that blue wave joined Democrats to pass it.

Louisiana Governor John Bel Edwards, who issued an executive order on his first day in office to expand Medicaid, is now running for re-election touting that decision; voters will give their verdict in October.

In Mississippi, Attorney General Jim Hood is also making expanded Medicaid the centerpiece of his gubernatorial campaign this year, arguing that his state, with the nation’s highest poverty rate, is cutting off its nose to spite its face by refusing to extend coverage to people who would benefit from it.

In Arkansas and Kentucky, where Democratic governors managed to push through expansion in 2014, the Republicans who replaced them have left the programs essentially intact, although they have fiddled at the edges by imposing premiums and work requirements on recipients. (Federal judges have blocked those changes.)

Die-hard Obamacare opponents have not been able to scuttle the program in either state — even in Arkansas, where the program has to be reauthorized annually by a three-fourths majority in both houses of the legislature.

In Florida and Oklahoma, supporters of expansion — including groups representing doctors, nurses and hospitals — are trying to put constitutional amendments expanding Medicaid coverage on the ballot in 2020.

Those ballot measures will be a key test of whether the public mood is more sympathetic to the idea of expansion than are the states’ conservative leaders, who have argued that the program is unaffordable and discourages people from seeking employment to secure health care.

However, the strategy of pursuing ballot initiatives is of limited use in the South because among states that haven’t expanded Medicaid, only Florida, Oklahoma and Mississippi allow the public to put measures on the ballot via petition. Texas, Georgia, Alabama, Tennessee, North Carolina, and South Carolina do not.

In Florida, the ballot measure will also need to get approval from 60 percent of the voters to pass.

The question to be answered this year and next is whether the fiscal and philosophical arguments against expansion will hold against the argument that low-income Southerners — rural and urban, black and white — deserve health care coverage and will benefit from it, in spite of its association with Obamacare.

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Georgia governor’s debate: Candidates clash over allegations of voter suppression

Kemp insists he is “absolutely not” trying to keep down the minority vote; Abrams says voters are “scared”

♦By Rich Shumate, ChickenFriedPolitics.com editor

Watch full debate on GPB

ATLANTA (CFP) — The charge that Georgia’s Republican Secretary of State Brian Kemp has been deliberately disenfranchising minority voters to gain an edge for his campaign for governor took center stage at a debate where he faced off with his Democratic challenger, Stacey Abrams.

Abrams and Kemp square off in first debate (Courtesy GPB)

In their first face-to-face encounter, aired October 23 by Georgia Public Broadcasting, Kemp insisted that he has “absolutely not” been targeting voters based on race, a charge made by Abrams and other voting rights advocates amid news reports that more than 50,000 voter registrations are being held in Kemp’s office because of paperwork errors.

But Abrams said Kemp’s office, by systematically removing voters from the registration rolls and holding up new registrations, has created a climate of fear for potential voters.

“They’ve been purged, they’ve been suppressed, they’ve been scared,” she said. “Voting suppression is not only about blocking the vote. It’s about creating an atmosphere of fear, making people worry that their votes won’t count.

Kemp insisted that all of the voters with registrations pending will still be allowed to vote and called allegations of voter suppression “a distraction to take away from Ms. Abrams’s extreme agenda.”

He also charged that Abrams has been encouraging illegal immigrants to come out and vote for her, an allegation she denied.

“I only believe that those who have a legal eligibility to vote should cast a ballot,” she said.

Kemp, who oversees elections as secretary of state, also said that he would not recuse himself if the governor’s race ends in a recount because recounts are primarily the responsibility of county officials, not his office.

“I took an oath of office to serve as secretary of state, and that’s exactly what I’m going to continue to do,” he said

While the candidates had expected disagreements on immigration and expanding Medicare, the debate, sponsored by the Atlanta Press Club, began with a question about an incident from Abrams’s past that rocketed through cyberspace on the day for the debate – her participation in a 1992 protest where the Georgia state flag, which then featured the Confederate battle ensign, was set on fire.

“Twenty-six years ago, as a college freshman, I along with many other Georgians, including the governor of Georgia, were deeply disturbed by the racial divisiveness that was embedded in the state flag with that Confederate symbol,” she said.

“I took an action of peaceful protest. I said that that was wrong, and 10 years later, my opponent, Brian Kemp actually voted to remove that symbol (as a state senator).”

Although the flag burning issue has been gathering widespread attention, neither Kemp nor Libertarian nominee, Ted Metz, brought it up again during the rest of the debate. The Confederate emblem was removed from the state flag in 2001.

In her campaign, Abrams has been calling for expanding Medicaid under Obamacare, an idea that has been blocked by Republicans in the Georgia Legislature. In the debate, she touted Medicaid expansion as a way to spur economic development in rural areas.

“Rural Georgia has been losing hospitals at an alarming rate, and because of that loss we have companies leaving, we have people without access to health care, we’re not doing the kind of economic development work we can do,” she said, adding that expanding Medicaid would bring $3 billion in federal money to the state and create 56,000 jobs.

But Kemp, who opposes Medicaid expansion, said that “expanding a broken government program is no answer to solving the problem.”

He also pointed to a book Abrams wrote in which she called for a single-payer government health plan financed by tax increases and cuts in Medicaid and Medicare, an idea he called “radical.”

“Abrams’s plan will make your current insurance plan illegal. It will not allow you to choose your doctor, and she’s going to raise your taxes to pay for it,” he said. “And if you’re on Medicaid or Medicare, this should scare you to death.”

Kemp also criticized Abrams for wanting to extend the state’s HOPE scholarship program for high school students to Georgia graduates who were brought into the country illegally as children, commonly known as Dreamers. He said he also opposes allowing them to attend state colleges.

“I’ve been running my whole campaign on putting Georgians first. I think we need to continue to do that,” he said. “I think we need to continue to fight for our own people, our own state.”

But Abrams said, “I stand by believing that every Georgian who graduates from our high schools should be allowed to attend our colleges, and if they’re eligible, receive the HOPE scholarship.”

Abrams, 44, is an Atlanta attorney and former Democratic minority leader in the Georgia House of Representatives. Kemp is a former state senator from Athens who has served two terms as secretary of state.

They are scheduled to meet for a second and final debate on November 4, the Sunday before the November 6 election.

With polls showing a close race and Metz on the ballot, the governor’s race in the Peach State could be headed to a runoff.

Georgia is the only state that requires a general election winner to capture a majority of the vote. If neither Abrams or Kemp win a majority, a runoff between them will be held December 4.

In the last open race for governor, in 2010, the Libertarian nominee got 4 percent of the vote

General election runoffs, while rare, have proven to have unpredictable results. In 1992, Republican Paul Coverdell ousted Democratic U.S. Senator Wyche Fowler in a runoff, even though Fowler had come out slightly ahead in the initial vote.

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