MARY LOUISE KELLY, HOST:
Congressional Democrats campaigned on health care in their quest to take back the House of Representatives. It worked. They won. But as NPR's Alison Kodjak reports, it's where you live that determines how your health care could be affected.
ALISON KODJAK, BYLINE: The first takeaway from this week's election results is that the Affordable Care Act is here to stay. Rodney Whitlock is vice president of health policy at ML Strategies.
RODNEY WHITLOCK: For health care, the most important thing is the House did change hands. Republicans will not be in charge in the House, which means any return to the concept of repeal and replace during at least the next two years is off the table.
KODJAK: Whitlock was on Republican staff in the Senate and worked on the Affordable Care Act. He said the second and perhaps bigger takeaway - how your health care looks depends an awful lot on where you live.
WHITLOCK: I think you will see state to state, particularly states that are bluer, more Democratic in nature, they're probably going to look in the direction of what can we do to bolster the ACA in the absence of a strong federal role in doing so. But you'll see states that are redder, the Republican states, take a very different approach.
KODJAK: Whitlock says those differences may show up because states regulate the ACA markets. More liberal states may follow New Jersey, for example, and impose their own individual mandates, the requirement that everyone have health insurance. Conservative states, by contrast, could allow residents to use federal subsidies to buy insurance that doesn't meet ACA coverage requirements. But the most visible differences show up in Medicaid, says Cindy Mann, a partner at Manatt Health who directed Medicaid during the Obama administration.
CINDY MANN: We have 33 states now that have expanded Medicaid, red and blue states. But the remaining states, millions of people have been left uninsured. The election ensures that that will change.
KODJAK: Voters in Idaho, Utah and Nebraska approved ballot measures to expand Medicaid in their states. When those programs go into effect, about 300,000 people who don't have insurance today will have access to coverage.
MANN: And it'll likely be expanded in Kansas and Wisconsin. And the Maine voters who voted for expansion through a ballot last year, their expansion may finally come to fruition.
KODJAK: That's because those states elected Democratic governors who have said they want to extend Medicaid benefits to more low-income residents. And in Wisconsin, where Democrat Tony Evers defeated incumbent Republican Scott Walker, Mann says the state is now unlikely to implement changes to Medicaid that Walker championed. It was just last week that the Trump administration approved Walker's waiver, or request, to require some Medicaid patients to work to keep their benefits.
MANN: Nobody has to implement the (laughter) waiver. Waivers can come and go at state decision.
KODJAK: The election results will also impact hospitals and insurers. Marc Harrison knows this firsthand. He's the CEO of Intermountain Healthcare, the biggest health system in Utah, a state that just voted to expand Medicaid.
MARC HARRISON: We are on the front lines. So this is all very real to us.
KODJAK: Intermountain also has an insurance arm, which covers more Medicaid patients than any other company in the state. So Harrison says the change will give patients more stability but will also cut down on the amount of free care the company provides.
HARRISON: We take care of everybody without regard for their ability to pay. And we're probably already taking care of a lot of these people already.
KODJAK: After this election, Intermountain's more likely to get paid for that care. That's not necessarily true in other states because as the election results make clear, who's running your state can make a big difference. Alison Kodjak, NPR News.
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