Health care is still a winning issue for Democrats

Beshear, the son of the state’s last Democratic governor who fully embraced the Affordable Care Act, made Obamacare and protecting Medicaid expansion a major theme of his campaign, right behind public education. In Virginia, Democrats promised to defend Medicaid expansion and criticized Republicans who for years had opposed the program, which has covered more than 300,000 poor adults in the state since enrollment began last November.

It was a return to a theme that lifted Democrats across the country last year, and Democrats are hoping it’s a preview of more to come next year.

“I fully expect health care to be as front and center in 2020 as it was in 2018,” said Geoff Garin, president of the Democratic-aligned polling firm Hart Research Associates. “We saw signs of that yesterday.”

That could spell trouble for Republicans if a Trump-backed lawsuit aimed at scrapping all of Obamacare is successful. A federal appeals court is expected to rule imminently on the law’s validity after a federal judge in Texas last year declared it unconstitutional, putting at risk health coverage for millions and insurance protections. No matter the outcome, the court’s decision is likely to be appealed to the Supreme Court, with a final verdict possibly landing in the thick of campaign season next year.

Democratic state legislators next year will look to remind voters of their support for Obamacare’s robust protections. A spokesperson for Virginia Senate Democrats on Wednesday said lawmakers are expected next year to introduce a bill enshrining Obamacare patient protections into state law.

Medicaid work rules are in trouble

Beshear, who leads by around 5,200 votes in a race that still hasn’t been called, pledged to immediately scrap Gov. Matt Bevin’s controversial Medicaid overhaul, which includes the first-ever work rules approved by the Trump administration.

A work requirement, approved in nine states so far, is the Trump administration’s signature effort to chip away at Obamacare’s Medicaid expansion. Bevin’s administration estimated his Medicaid plan would have shrunk enrollment by 95,000 people, and the cuts could have been even deeper if Bevin won. He promised to undo the state’s entire Medicaid expansion, covering more than 400,000 adults, if the courts ultimately ruled against his program.

The work rules have run into legal trouble since the administration began approving them last year. A federal judge blocked the rules in Kentucky, as well as Arkansas and New Hampshire. The Trump administration is likely to keep defending the Kentucky work rules, which are now being reviewed by a federal appeals court. Republican officials in Arizona and Indiana last month also suspended their rules, citing the uncertainty around ongoing litigation.

The future of Virginia’s Medicaid work requirement is also an open question, now that the legislature his flipped to full Democratic control. Democratic Gov. Ralph Northam agreed to the work rules last year to secure Republican support for Medicaid expansion, but he’s still negotiating the details with the Trump administration and recently threatened to drop the requirement over a funding disagreement. Democrats this year didn’t campaign on rolling back the rules, but the House Democratic leader this summer said they needed to discuss the option.

But health care isn’t enough in the Deep South

Democrat Jim Hood made Mississippi’s gubernatorial race unusually competitive, but his support for Medicaid expansion in one of the poorest and unhealthiest states in the country wasn’t enough to win. Lt. Gov. Tate Reeves, a fiscal conservative who defeated Hood, has said he won’t adopt the coverage program, which would cover roughly 300,000 poor Mississippians.

Hood now joins the ranks of other southern Democrats who made Medicaid expansion the crux of their gubernatorial campaigns and lost. Georgia’s Stacey Abrams and Florida’s Andrew Gillum both narrowly lost elections last year in two of the larger states that haven't expanded Medicaid. In total, 14 states have not expanded.

Louisiana, one of two Deep South states that did expand Medicaid, appears likely to keep the coverage program no matter who wins the Nov. 16 runoff election. Republican candidate Eddie Rispone has said he would seek to freeze enrollment in the Medicaid expansion, which Democratic Gov. John Bel Edwards enacted through executive order in 2016 upon taking office.

Abortion attacks didn’t hurt Democrats

In the closing weeks of the Kentucky race, Bevin clobbered Beshear over the Democrat’s support for abortion rights. Bevin thought the attacks could have been potent in a state where most people believe abortion should be illegal, but they ultimately weren’t enough to save the unpopular Republican incumbent.

Beshear supports Roe v. Wade and as attorney general refused to defend some of the state’s strict anti-abortion laws. He was the first Kentucky gubernatorial candidate to earn an endorsement from the abortion rights group NARAL Pro-Choice America. The prominent anti-abortion group Susan B. Anthony List spent $750,000 attacking Beshear and other down-ballot Democrats in the state.

In Virginia, Northam’s controversial comments on abortions later in pregnancy generated a national firestorm earlier this year, but they ultimately didn’t hurt Democrats in legislative races. Their candidates were also helped by millions of dollars from abortion rights groups.