The midterm elections cemented Obamacare's legacy and showed Democrats can actually win on healthcare

Just two years after the future of the law was seriously in doubt, the results of Tuesday night's midterm elections solidified Obamacare's standing as the law of the land and showed that many aspects of the landmark healthcare law are getting more popular.

Democrats ran hard on the preservation of key aspects of the Affordable Care Act, a choice that many in the party credit for their House victory. A handful of states also voted to expand their Medicaid programs under Obamacare.

Democrats won the messaging fight on healthcare

With Democrats regaining control of the House, the GOP push to repeal and replace Obamacare is buried for the time being. If you ask Democrats, the prospect of another shot at repeal helped propel the party to victory.

Democratic Leader Nancy Pelosi, widely assumed to be the next speaker of the House, pointed directly to healthcare as the key to the party's path to the majority.

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The ACA is polling near its highest level ever. And many of the law's provisions, including protections for people with preexisting conditions, remain significantly popular. The rising popularity and the GOP's legislative attacks on Obamacare allowed Democrats to draw a stark contrast with their Republican opponents.

Healthcare ranked as the top issue for voters in exit polling, and Americans generally trusted Democrats more than Republicans. According to an exit poll of 75 competitive, GOP-held districts by the left-leaning Public Policy Polling, 52% of people said they trusted Democrats more on healthcare, compared to just 44% who trusted the GOP more.

The switch represents a huge change from the 2010 and 2014 midterms, when Republicans hammered Democrats on the ACA and healthcare in general.

An outstanding question, however, is what exactly Congress could do to shore up Obamacare in a divided Congress. A bipartisan push to reinforce the law's individual insurance markets fell through in 2017, but McConnell hinted that another deal could be on the docket in 2019.

Medicaid expansion is a winner

Perhaps most significant for Obamacare's legacy is the continued popularity of the law's Medicaid expansion. The ACA allows states to expand Medicaid eligibility to people making up to 138% of the federal poverty limit, helping low-income Americans gain access to healthcare.

Expansion is heavily subsidized by the federal government to ease the cost burden on states, but many state-level Republicans have rejected the idea due to budgetary concerns. But slowly, the protestations of the GOP are giving way to a gradual march of Medicaid expansion.

Three deep-red states — Idaho, Nebraska, and Utah — joined the 32 expansion states via ballot initiatives on Tuesday. Solid majorities in each state voted for expansion, which will help roughly 325,000 people gain access to Medicaid.

In addition to the direct pick ups for expansion, a couple of governor's races could lead to additional gains:

around 150,000 more people
governor-elect in Wisconsin
, could also accept federal aid to boost the state's Medicaid program and extend
coverage to another 176,000 people
in the state.
70,000 people in the state
could be eligible for Medicaid if expansion moves forward.

Other states could see expansion, like in North Carolina, where Republicans lost their supermajority in the state legislature, but that remains less likely.

In total, with the ballot initiatives and governors' races, up to 721,000 Americans could gain access to healthcare via Medicaid expansion in the wake of the midterms.

The midterm elections cemented Obamacare's legacy and showed Democrats can actually win on healthcare

Democrats won the messaging fight on healthcare

Medicaid expansion is a winner

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