Republican and Democratic governors have strikingly different visions for the future of health care, according to a new analysis published in the American Journal of Public Health. While Republican leaders favor maintaining or shrinking public health insurance programs, Democratic leaders are advancing several new proposals to expand public coverage, including “public option” and single-payer health reforms.

Researchers analyzed the health care platforms of the 72 Republican and Democratic nominees running for governor in the 2018 election, examining position statements posted on campaign websites. They identified four major health care reform proposals advanced by gubernatorial candidates: introducing work requirements for Medicaid, expanding Medicaid in states that have not yet done so, creating a public insurance option, and transitioning to a state-based single-payer system.

Five Republican nominees proposed adding work requirements for their state’s Medicaid program, of whom one was elected (in Ohio). In the 22 states that had previously expanded Medicaid, no candidate from either party proposed rolling back coverage.

Six Democratic nominees proposed creating a new public insurance option to compete alongside private plans, of whom five were elected. Importantly, a public option was proposed by newly elected governors in Illinois, Colorado, New Mexico, and Maine who will be working with Democratic state legislatures, bolstering the political viability of reform. Seven Democratic nominees proposed single-payer health care plans, of whom three were elected. These newly elected governors—in California, Colorado, and New Mexico—will all be working with Democratic-controlled state legislatures.

All Democratic nominees included health care platforms on their campaign websites, but only half of Republican nominees did so. Their omission did not appear to have electoral consequences: 13 of the 18 Republicans offering no health care platform won their elections.

According to Micah Johnson, an author of the AJPH article and M.D. candidate at Harvard Medical School, “With a divided government in Washington, states have an opening to provide leadership on health reform in the next two years. State efforts to expand public coverage could serve as a model for future national reform, much as the Massachusetts health reform plan in 2006 provided the blueprint for the Affordable Care Act.”

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