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Opinion A huge blow to Obamacare? Maybe not so much.

Kentucky Governor-elect Matt Bevin (AP Photo/Timothy D. Easley)

When full-blown Tea Partyer Matt Bevin decisively won the Kentucky gubernatorial contest last month, some major news organizations were quick to proclaim that this could prove disastrous for Obamacare in a state where it had registered as a surprise success. The New York Times opined: “Kentucky may become a laboratory for the kind of rollback that the law’s opponents have so far only dreamed of.”

And it’s true that this could still happen, if Bevin does end up rolling back the Medicaid expansion and dismantling the exchange in the state. But here’s an alternative possibility. Although Kentucky received all the attention, the Democratic win in the Louisiana gubernatorial contest also could have far-reaching implications for Obamacare — ones that end up offsetting or even overshadowing what happens in Kentucky.

Indeed, it’s plausible that the upshot of both gubernatorial outcomes, taken together, could end up being more people enrolled in Obamacare, rather than fewer.

A new Kaiser Family Foundation poll of Kentucky out today finds that seven in ten of the state’s residents want to keep the Medicaid expansion in the state as it is. Even 54 percent of Republicans, and 43 percent of those who voted for Bevin, say the same. (This, even though Kentuckians have an unfavorable view of that thing called the Affordable Care Act, a.k.a. Obamacare, by 49-41, which is now an old story.)

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The widespread support in Kentucky for leaving in place the Medicaid expansion — which has impacted 425,000 people, according to Kaiser — is bound to renew questions about what Bevin will end up doing. That remains unclear. During the campaign he called for rolling back the Medicaid expansion, but since then he has backpedaled and instead has suggested he may recast the program by not enrolling people “at the same level.” He may seek a waiver to merely alter the program.

That would be consistent with what Bevin suggested in his inaugural address, that he might remodel the Kentucky Medicaid expansion on what was done in Indiana, which would mean beneficiaries pay some kind of premiums, giving them “skin in the game.” If Bevin goes that route, it might end up reducing the number of Kentuckians on the Medicaid expansion, but by far less than rolling it back would.

Meanwhile, in Louisiana, incoming Democratic governor John Bel Edwards has said that opting the state in to the Medicaid expansion will be one of his “highest priorities.” Local reports indicate that, while legislators had previously been hostile to the idea, they now appear more open to expanding Medicaid with Bel Edwards coming in, and they are engaging the idea seriously. Kaiser estimates that some 192,000 Louisianans could be eligible for coverage under the expansion, if it happens.

What’s the upshot of all this? Kaiser’s Larry Levitt emails:

Depending on how things shake out, it’s entirely possible that the net effect of the elections in these two southern states could be to increase the number of people enrolled in ACA-related programs and decrease the number of people uninsured.
If Louisiana expands Medicaid, it would extend eligibility to 192,000 uninsured residents now not eligible for any health care help. What happens in Kentucky depends on what the new governor ultimately proposes. Eliminating Kynect, the state insurance marketplace, could have some effect on coverage because of the loss of local outreach efforts, but all Kynect enrollees would be eligible for the same subsidies through that they now receive. Backing off the Medicaid expansion entirely would take coverage away from a lot of people, though the governor-elect has also suggested keeping the Medicaid expansion in place while altering it through a waiver. Some Medicaid beneficiaries might drop out if, for example, the program started charging premiums like in Indiana, but many would remain covered.
It could be that the net effect of these two elections is to expand coverage.

Again, we don’t know what will happen in either state. It’s possible Bevin will roll back the Medicaid expansion and Louisiana will fail to opt into it, which would amount to a serious setback for Obamacare. And the Kentucky loss was already a blow to the law in another sense: Democrats had hoped to show that the politics of the law are not as they appear — that arguing Republicans plan to take its benefits away from people can win even on political turf where voters are hostile to government activism. Obviously that didn’t happen in Kentucky.

But at the end of the day, the overall impact of these two southern elections, taken together, could end up being a wash in terms of the coverage expansion, or even possibly a net positive for the law. Not that this will be the storyline in D.C., needless to say.