Conservatives have long-expressed concerns about Donald Trump’s conflicting and muddled statements about health care policy, fearing that a Trump presidency would lead to a continuation of Obamacare or, perhaps, a TrumpCare that strongly resembles the Affordable Care Act.
In fact, the polls as of today indicate Trump is unlikely to get the chance to betray conservatives on health care.
What is far more likely is that Trump’s embattled campaign will hurt Republican candidates across the country in both federal and state elections, leading to Democratic control of more state governments and potentially Democratic control of the U.S. Congress.
Modern Healthcare points out, for instance, that a bad election for Trump could lead to more states expanding Medicaid.
In North Carolina, for instance, incumbent Republican Gov. Pat McCrory is fighting a tough re-election battle against Democrat Roy Cooper. If Cooper prevails, he will likely move to embrace the Medicaid expansion that McCrory rejected.
Even if Republicans maintain control of the legislature in the Tar Heel State, it is likely that Democrats will be able to muster a pro-Medicaid expansion coalition that includes some Republicans, who are under increasing pressure from constituents to support a policy that has brought coverage to millions in other states.
The situation is similar in Missouri, where Republican Eric Greitens and Democrat Chris Koster are locked in a tight race. Although incumbent Democrat Jay Nixon supported the expansion, he was unable to get it approved by the GOP-controlled legislature. If Democrats make gains in the legislature, however, they may also be able to get expansion approved.
In other states, a previously-implemented Medicaid expansion may be imperiled by Republican candidates who threaten to undo it or at least change it.
In New Hampshire, for instance, former U.S. Sen. John Sununu says he will reform the Medicaid expansion implemented by the incumbent Democratic governor by imposing work requirements.
Republican challengers in Montana and North Dakota have previously expressed opposition to the expansion, but it is unclear whether they will be able to repeal it entirely if elected, considering that in both cases it was GOP-controlled legislatures that approved the expansion.
But while state legislators have increasingly moved towards embracing Medicaid expansion, it is unclear how much, if at all, Republicans in Congress will budge on their opposition to the ACA if Hillary Clinton is elected, particularly if they maintain control of the House of Representatives and are able to block whatever “fixes” Clinton plans for the ACA.