Six years after its passage on a party-line vote, the Affordable Care Act remains controversial. Nineteen states still refuse to expand Medicaid eligibility as allowed under the law, a major avenue by which uninsured people were to find health insurance.
However, six months before the Nov. 8 presidential election, expansion of Medicaid could become a pivotal issue among an important and growing voting bloc: Latinos.
Republican presidential candidates this cycle have largely adhered to the party orthodoxy of opposing every piece of President Barack Obama's healthcare overhaul -- though the presumptive nominee, Donald J. Trump, has been an exception. Trump, while maintaining that he wants to repeal and replace the ACA, has declined to denounce state Medicaid expansion but has called for "block granting" the program, which would allow states to reduce benefits and enrollment.
Meanwhile, Democratic candidates have argued over whether the law goes far enough in broadening access to care.
This summer, as the political season changes from primaries to the general election, will Latinos' embrace of Medicaid expansion hold sway over the party nominees?
Why Medicaid Matters to Latino Families
No demographic group has benefited more from Medicaid and the ACA than Latinos, who accounted for nearly a third of newly covered adults under the law, far more than their 17 percent proportion of U.S. adults. And of new enrollments under the ACA, 71 percent gained coverage via the Medicaid expansions.
Additionally, Medicaid is an essential lifeline for many Latino families, covering more than half of Latino children. And, thanks to Medicaid expansion, uninsured rates for Latino children have reached a historic low of 9.7 percent.
But while Latinos have significantly benefited from the ACA's expansion of Medicaid, more work remains to be done. A Department of Health and Human Services report found that if all states expanded Medicaid, 95 percent of uninsured Latinos might qualify for Medicaid, the Children's Health Insurance Program (CHIP), or tax credits to help with healthcare premiums.
Why Latinos Could Shape the 2016 Election
Medicaid expansion has significantly benefited Latino families, so it's little wonder they feel strongly about it. In a November 2014 poll of Latino voters, 77 percent nationwide said states should take money to expand Medicaid programs, with only 15 percent opposed.
And although nobody knows what the outcome of the 2016 presidential election might be, there's evidence that Latinos' support of expanding Medicaid might translate into votes against the Republican candidate. During the most recent statewide elections in the pivotal swing state of Florida, 66 percent of Latino voters said they would be more likely to support a gubernatorial candidate who favored Medicaid expansion. Only 17 percent said they would be less likely to support a candidate who favored expansion.
What's more, U.S. demographic trends mean Latinos will have more say than ever in the 2016 election. Of the 10.7 million new eligible voters since 2012, more than two-thirds are from a racial or ethnic minority, and Latinos are expected to cast 10 percent of all ballots this November, up from less than 4 percent in 1992.
Considering that congressional Republicans have voted 62 times to repeal the ACA and Medicaid expansion, those numbers doesn't bode well for the Republican nominee come November, none of whom has voiced support for expansion. Democratic contenders Hillary Clinton and Bernie Sanders, meanwhile, both advocate Medicaid expansion.
Why Latinos Embrace Medicaid
Although Medicaid expansion has greatly increased health coverage among the Latino community, coverage numbers alone don't tell the whole story. They gloss over how Latinos benefit from that coverage.
The simple answer is that health insurance is a life-changing benefit. A 2012 New England Journal of Medicine study found that Medicaid enrollees had lower rates of mortality than that their uninsured peers. A study in Oregon found that enrollees were more likely to have their diabetes diagnosed and treated and less likely to suffer from depression.
The financial benefits are real, too. Medicaid enrollees are 40 percent less likely to have medical debt than their uninsured peers. Even people with private insurance can face financial ruin if they experience large out-of-pocket costs. Medicaid, by contrast, provides care at little to no out-of-pocket cost for enrollees, and it comes with dental and vision care at no additional cost.
For working families who are trying to make ends meet, the quality, low-cost health insurance that Medicaid provides can drastically improve quality of life. It's something more and more Latino families are finding out, and it may be something the presidential candidates must come to accept as well.
Benjamin Geyerhahn is an experienced entrepreneur, a healthcare policy expert, and a member of New York Governor Andrew Cuomo's Health Benefit Exchange Regional Advisory Committee. He is the founder and CEO of BeneStream, which uses a combination of technology and a multilingual call center to guide employers and employees through the Medicaid enrollment process.