No other policy issue dominated the headlines quite like health care this year. As Congress repeatedly tried to repeal and replace -- and then tweak -- President Obama's Affordable Care Act (ACA), angry and emotional citizens flocked to town halls to make their voices heard.
On Tuesday, voters in several states get to bypass their representatives and make some decisions about the direction of health policy in their state.
With governor's races in New Jersey and Virginia and high-profile health-care ballot measures in Maine and Ohio, voters could change policies -- or elect someone who will change policies -- surrounding Medicaid, abortion and drug prices.
While there are far fewer races and ballot measures this year compared to next, Tuesday's elections could indicate how the Trump agenda and congressional inaction on health care might impact the public's vote in 2018.
Virginia
In Virginia, residents will be voting between Democratic Lt. Gov. Ralph Northam and well-known Republican lobbyist Ed Gillespie. (Democratic Gov. Terry McAuliffe is limited to just one term.) The race is close, with Northam's polling lead getting smaller as the election nears.Northam, who is also a physician, has made health-care issues a central part of his campaign. He advocates for Medicaid expansion, a central provision of the ACA that the McAuliffe administration repeatedly tried to get the Republican-controlled legislature to approve. Gov. McAuliffe has said he’ll add Medicaid expansion into the budget he submits in December. But if the legislature still refuses it, Northam promises to continue the fight.
“It’s time to put the excuses aside and take the politics out of it,” Northam told The Washington Post.
He’s been particularly outspoken on the campaign trail about women’s health, vowing to protect Planned Parenthood funding and expand access to long-acting reversible contraceptives, such as IUDs. He’s also talked extensively about gun violence as a public health issue and promised to restore a state law that only allowed residents to buy one handgun a month.
Gillespie, on the other hand, does not support expanding Medicaid. He says the costs of doing so aren't sustainable. (The federal government pays 90 to 100 percent of states' costs of making more low-income people eligible for Medicaid.) He has said that he favors a full ban on abortion except in cases of rape, incest or life endangerment. While enacting a restriction that extreme might not pass legal muster, he's campaigned on more likely actions, such as defunding Planned Parenthood and supporting a 20-week abortion ban.
He’s largely shied away from commenting on the health-care debate in Congress, instead promising to bring down health-care costs and increase health insurance competition in Virginia by creating compacts with nearby states so plans can be sold across states lines. States are already allowed to do this, but insurance companies have shown little to no interest in cross-state plans.
Both candidates have spoken in favor of expanding mental health services, especially in light of the opioid epidemic.
Virginia is considered a purple state. The majority of the state votes consistently Republican, but densely populated Northern Virginia just outside Washington, D.C., is deep blue territory.
It’s going to be a tight race: In a Washington Post poll from Oct. 31, Northam has a slight lead with 49 percent, Gillespie at 44 percent and Libertarian candidate Cliff Hydra with 4 percent of those polled.
New Jersey
Health care hasn’t been causing much of a wave in New Jersey’s gubernatorial race. In fact, Republican candidate Kim Guadagno -- the current lieutenant governor -- doesn’t even list health care as a policy issue on her campaign website. She hasn't really discussed the ACA or abortion.“Pro-life just isn’t a winning position in New Jersey,” says Joel Cantor, professor of public policy at the Center for State Health Policy at Rutgers University.
Instead, she’s taken a more hardline approach to immigration by bashing so-called sanctuary cities and states, likely in order to appeal to the Trump base.
Guadagno has, however, promised to make investments to address the opioid epidemic. Current Gov. Chris Christie, who is term-limited, has made the opioid epidemic a central theme in the last years of his tenure, most notably by sitting on President Trump’s Commission on Opioid Abuse. He also pledged $200 million to address the epidemic and expanded the drug court system in New Jersey.
Meanwhile, Democratic challenger Phil Murphy, a businessman, talks about health care largely in terms of upholding the tenets of the ACA. (Even though GOP Gov. Christie publicly denounced the ACA during his tenure, he opted to expand Medicaid under the law in 2013.) Murphy is also in favor of expanding women’s health and has promised to protect funding for Planned Parenthood if Congress slashes it.
Most dramatically, Murphy supports making recreational marijuana legal within his first 100 days, calling it a “social justice issue.” Medical marijuana is currently legal in New Jersey.
New Jersey's race isn't as much of a nailbiter. Murphy has a double digit lead in several polls, perhaps in large part to current Gov. Chris Christie’s unpopularity. The latest poll from Morning Consult has his approval rating at just 18 percent -- the lowest in the country.
Maine
Maine residents will be voting on what's likely the most closely watched ballot measure on Tuesday.If passed, the state would become the 33rd to expand Medicaid and signal support for the ACA at a time when President Trump is taking major steps to reverse it.
The Maine Legislature has voted to expand Medicaid five times in the last five years. But every time the bill reached GOP Gov. Paul LePage's desk, he vetoed it. So advocates of expanding Medicaid decided to go straight to voters.
LePage and opponents of the measure point to a failed effort to expand Medicaid more than a decade ago that drove up Medicaid costs so much that the state fell behind on hospital reimbursements.
Supporters of the measure say that with financial help from the federal government, expansion is worth a try. (The federal government pays 100 percent of the costs of increasing Medicaid eligibility to people who make incomes up to 138 percent of the federal poverty line, which is $32,000 for a family of four. Gradually, the feds' bill drops to 90 percent.)
There’s been no formal polling on the measure, but supporters have far outraised the opponents: They have $2 million dollars of cash on hand, while opponents have just over $400,000.
Ohio
Ohio is voting on a ballot measure that failed in California last year. If it passes, it would be the first law of its kind in the nation.Pharmaceutical companies have few price regulations, but states are starting to change that. The Ohio ballot measure would let state health agencies pay the same for prescription drugs as the U.S. Department of Veterans Affairs, which gets a 24 percent discount off drug manufacturers' prices.
Supporters calculated that it would save the state $400 million a year, but opponents say that number is grossly overestimated.
It’s the most expensive ballot measure in Ohio’s history. Backed by pharmaceutical interests, the opponent camp has raised more than $58 million. The supporters of the measure, largely financed by the AIDS Healthcare Foundation, have $16 million on hand.
A poll in August found that most Ohioans were undecided about the issue.
This story is part of our elections coverage. Read our list of the most important races and ballot measures to watch here.
