In Ky. and elsewhere, elections may decide Medicaid expansion

In Texas, Brandi DeFrank's Medicaid
coverage ended when her baby, Gabriel,
was born. His coverage continued.

Voters' choices on Tuesday about who sits in statehouses may matter more in the long run than who they have chosen for president. Two of the biggest provisions of the Patient Protection and Affordable Care Act -- offering Medicaid to more people and setting up state health exchanges -- are in the hands of state officials who can either disrupt implementation of the law or move it forward. In Kentucky, Republicans are pressing to take over the state House and their leader, Rep. Jeff Hoover of Jamestown, has said the expansion would be too expensive, even with heavy federal subsidies.

Maggie Fox for NBC News contrasts the approach of Texas, which has refused $76 billion in federal matching funds to help it expand Medicaid in the next five years, to that of Vermont, which is wholeheartedly embracing the expansion. Texas has 6.3 million uninsured, reports Fox, a quarter of the state's population and the highest percentage of uninsured people in the country. "We're not going to part of socializing health care," said  Texas Gov. Rick Perry, a Republican.

“There are states referred to as ‘Hell, no’states,” said David Smith, an analyst at Leavitt Partners, a health-care consulting firm. And while 11 governorships are on the ballot on Tuesday, “a lot of those states don’t necessarily have governors who are up for election,” said Smith. In those states, voters have to decide whether to help governors by electing members of the same party to the state house.

In other states, it's more straightforward. Alabama, Florida, Montana and Wyoming have ballot measures asking residents whether they want to block the mandate requiring people to get health insurance.  (Read more)