Beto bet on the expansion of Medicaid will it pay?

Beto O 'Rourke relied on his long campaign to beat Senator Ted Cruz to the idea that Obamacare should be even bigger in Texas – a state that has done more than anyone else to try to destroy the historic law on the health.

It could work.

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O'Rourke is approaching Cruz in several polls, a shocking development in a state that has not sent a democrat to the Senate since 1993.

However, O'Rourke's attention to Obamacare – he's talking about expanding Medicaid at every campaign event – has raised the eyebrows to deep red. After all, the Democrats' attempts to campaign on Medicaid expansion under the Health Act have faded, largely because the most concerned Texans did not participate in the vote. Four years ago, Wendy Davis repeatedly called for the Medicaid expansion and lost the governor's race by more than 20 points.

Cruz, for its part, campaigns mainly on Cultural warfare issues like guns and NFL players kneeling, but he also holds to the promise to repeal Obamacare who brought him into office in 2012. As for the Expansion of Medicaid, he told POLITICO that "it would hurt millions of Texans".

Texas political experts are divided as to whether O'Rourke and his health care-focused campaign can overcome the state's catastrophic electoral turnout and low public awareness of health care and how it works.

"The populations that would benefit most from the expansion of Medicaid, and who would support it the most, are poor people and people of color," said Gabriel Sanchez, director of the Latino Decisions polling and voting office. of the Robert Wood Johnson Foundation for Health. Policy. "But it's the groups that tend to have the lowest voter turnout, especially in a one-year non-presidential election. And there are not really any signs of change this year.

Democrats say the signs of 2018 may be different – but how much remains to be seen. Popular interest in the Medicaid extension resonated during this campaign cycle, not only in Texas, but also in other red states like Idaho, Nebraska and Utah, giving candidates like O'Rourke the hope of winning.

Recent polls also show a strong majority of Texans with O'Rourke regarding Medicaid. A survey conducted in September by the Texas Medical Center found that 60% of Texans supported the expansion of Medicaid, including 57% of independents and 40% of Republicans. A similar survey conducted in June by the Houston-based Episcopal Health Foundation and the Kaiser Family Foundation was 64% approved.

Republicans suggest that the results of these polls are up to snuff: James Dickey, chairman of the Texas Republican Party, told POLITICO that the Medicaid expansion is only going well because people generally want their neighbors benefit from health insurance and are not asked to evaluate all possible options. .

Rather than "the Democratic approach of increasing the number of bureaucrats between patients and doctors," he said, "a market-based health system would benefit people the most. Competition reduces costs and increases quality. This is the solution that Republican leaders seek to offer to Texans and why Republicans will be re-elected in November. "

This message may be less convincing during the election campaign, as the Republicans failed to implement the reform even after taking control of all the powers of the Austin and Washington governments. and trust the Democrats more in defining their health policy.

Threats to ACA protections may also seem more immediate for Texans than most Americans. A lawsuit filed this year by the Attorney General of Texas aims to bring down the most popular object of Obamacare – protections for people with pre-existing conditions. And Cruz, who is perhaps best known for triggering a government shutdown because of Obamacare funding in 2013, continues to believe that he is working for his repeal.

Tariq Thowfeek, of the Texan Democratic Party, told POLITICO that O. Rourke was leading a different type of campaign from that of his predecessors. He ventured out of large urban centers of the state into small towns and rural counties. in plain language.

"He visits places that normally do not vote Democrats, and instead of talking about Obamacare or the Affordable Care Act, there has been an effort to talk about it in a more humane way," said Thowfeek. "He says things like," We should all agree that you should not have to break the bank to go to the doctor, "or" You should not drive 100 miles to go to the hospital "or" If you have an asthmatic child, his blanket is in play now, because it's a pre-existing condition.

Other factors could also work in O'Rourke's favor.

Support for Medicaid's expansion is particularly high among Latino voters – a demographic group that has traditionally not voted in large numbers and O'Rourke has to show up to win. Unidos and Hart Research revealed that 70% of respondents believe that the government should play a "major role" in ensuring that "all Americans have health insurance" and 82% in favor of Medicaid.

"When we talk about ensuring that every woman, child or man, can see a doctor, pay for drugs and get the health care they need to live their full potential, it starts with the expansion of Medicaid in the least insured state, "O & # 39; s Rourke's Communications Director, Chris Evans, told POLITICO. "Beto has talked about health care everywhere we go because that's the number one issue that Texans are facing in the hundreds of town halls we have organized throughout the state."

Evans also noted that the campaign has made the issue a centerpiece of its commercials, including statewide radio ads in English and Spanish.

The big question is whether Texans who hear and respond to these ads have actually voted, said Anne Dunkelberg, Program Director of the Health and Wellness Team at the Austin Center for Public Policy Priorities. .

"It has been some time since most Texans supported the expansion of Medicaid coverage," she said. "But one of the big challenges we have is that elected officials ignore the ballot because they know that many will not show up to vote."

Another factor that preserves the status quo is widespread confusion and misinformation about how Texans are coping with the health care needs of other states' residents, said Dunkelberg, who previously worked in the Medicaid Director's Office. . This summer, a Kaiser Family Foundation survey found that less than a third of Texans are aware that their country has the highest non-insurance rate in the country.

"Those who are uninsured themselves are not more likely than their insured counterparts to be aware of this fact," the survey concluded, noting that nearly 20 percent of those surveyed mistakenly thought the state should be aware of it. doing. better that most on this front.

"It was pretty shocking," said Dunkelberg.

For Sanchez to Latin American decisions, this lack of awareness feeds the uninformed vote, or even apathy.

"For most people, health policy is so complicated," he said. "Trump has been talking about killing her all the time, so many people think that Obamacare is no longer in place. There are many moderate Republicans in Texas, including many Latinos, who would benefit from an expansion. But because they do not understand it, they only vote by party. "