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State Political Shifts Likely To Affect Health Law

In a power shift that could affect how the federal health law is carried out, Democrats took complete control of five additional state legislatures on Tuesday, while Republicans added a governorship and control of three additional state legislatures .

All told, Republicans will have 30 governors and control 24 state legislatures next year, compared to 19 Democratic governors  and 18 Democratic-controlled legislatures. The rest are split or tied.

The Medicaid expansion and new insurance exchanges are the key ways the health overhaul expands coverage to as many as 30 million people starting in 2014. But the Supreme Court in June gave states the option to decide whether to expand Medicaid in 2014. Most states are undecided on expanding the state-federal health insurance program for the poor, though govenors in six states, including Florida and Texas, have said they oppose it. In the case of exchanges, the federal government will build the insurance marketplaces in states that don’t do it themselves. Only about 19 states so far have taken the first steps to start an exchange or to partner with the federal government to do it, and a Nov. 16 deadline is looming for states to provide their plans to the Obama administration.

Democrats took control of state legislatures in Maine, Minnesota, Colorado, New York and Oregon, according to the National Conference of State Legislatures, a nonpartisan trade group of state lawmakers.. The GOP took control of legislatures in Arkansas, Wisconsin and Alaska.

In New Hampshire, Democrat Maggie Hassan’s victory over Republican Ovide Lamontagne means the state will likely expand Medicaid as called for by the law and create an exchange to make it easier for individuals and small businesses to shop for affordable insurance plans. Hassan said she would do both if elected. Outgoing Gov. John Lynch, a Democrat, had left the decision to his successor.

The prospects for smooth implementation of the law in Indiana decreased with the election Tuesday of Mike Pence, a Republican, who has said he opposes starting a state-based exchange. He also  favors expanding Medicaid only if the state can limit benefits and ask recipients to pay higher premiums. The state’s outgoing GOP governor, Mitch Daniels, left the issues for his successor to decide.

In North Carolina, the election of Republican Pat McCrory  means that state is unlikely to expand Medicaid. McCrory has said he opposes the law, including  the Medicaid expansion . His Democratic opponent Walter Dalton favored the health law. The state’s outgoing governor, Bev Purdue, a Democrat, left the decision to her successor.

Democrat Steve Bullock,  who is leading in Montana’s gubernatorial race, is undecided on the Medicaid expansion and the creation of an insurance exchange. His Republican challenger, Rick Hill, said he was open to establishing the exchange but opposed a Medicaid expansion. Outgoing Gov. Brian Schweitzer was undecided on the issue.

Republican Gov. Gary Herbert of Utah, who was re-elected, opposes expanding Medicaid. His state has an insurance exchange dating back to 2008 and has been working to make changes to comply with the federal law.

Republican  Gov. Jack Dalrymple of North Dakota, who was also re-elected, has not taken a position on Medicaid expansion and has opposed  a state exchange

Several winners have yet to declare a position on implementing the health law, including Democrat Jay Nixon who won re-election as Missouri  governor.

Some Democratic incumbents who won re-election favor expansion, including Jack Markell in Delaware and Peter Shumlin in Vermont.