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Why health care has become a top issue for voters in deep red states

Polls show health care is one of the top issues for Americans this year. In heavily Republican Idaho, where state lawmakers haven’t expanded Medicaid coverage, voters petitioned to put the measure on the ballot. In partnership with Politico, John Yang reports on what expansion would mean for the thousands of residents earning too much to qualify for Medicaid, but too little for ACA subsidies.

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  • Judy Woodruff:

    The midterm election is a little more than two weeks away, and national polls show that health care is the top issue for voters in four heavily Republican states: Idaho, Montana, Utah, and Nebraska.

    The ballots will include initiatives on expanding Medicaid under the Affordable Care Act.

    John Yang goes to Idaho for a report produced in partnership with Politico.

  • John Yang:

    Nichole Stull's life in suburban Boise, Idaho, is overflowing — four bouncing daughters, age 4 to 14, and a baby on the way.

    With her husband, Jared, she runs a start-up that produces videos for local companies. But she also finds herself in a dangerous gap. They make too much money to qualify for traditional Medicaid in Idaho, but not enough to qualify for help to pay for premiums under the Affordable Care Act.

    So, for three years now, while the kids have been covered by Medicaid, mom and dad have gone without health insurance. It weighs on her mind as the years go by.

  • Nichole Stull:

    Like, I always joke that we have had the 'hope for the best' plan, which is OK when you're in your 20s and you're healthy. And we don't smoke, we don't drink, we don't do drugs. We eat as healthy as we can. We're active. So we do all of those things.

    But, as you get older, that doesn't work forever.

  • John Yang:

    Both Stull's mother and sister have been diagnosed with breast cancer, and she herself carries the BRCA2 gene, which is linked to breast cancer risk.

  • Nichole Stull:

    A lot of times, they say when you find the BRCA1 or the BRCA2, it's not a matter of if you get cancer, but when. So I would love to be able to get the care I need now, so that I can move forward without this ever-hanging presence and weight that possibly could happen.

  • John Yang:

    While she's pregnant, Stull has temporary Medicaid coverage. But she can't have the preventive surgery that her doctor recommends for her while she's expecting. And she will lose Medicaid shortly after giving birth.

    In the 17 states that have not expanded Medicaid coverage under the Affordable Care Act, more than two million people have the same trouble getting insurance. In Idaho, if a family of four earns more than about $5,200 a year, they don't qualify for traditional Medicaid. But if they make less than $24,600, they don't get help with Obamacare insurance premiums.

    They fall into what's known as the Medicaid coverage gap.

    Nichole Stull is among the estimated 62,000 people here in Idaho who fall into that gap. On Election Day, Idaho voters could do something that Idaho lawmakers haven't done: Give those people health insurance by expanding Medicaid.

  • Sam Sandmire, Reclaim Idaho:

    We're trying to get health care to 62,000 people in the gap.

  • John Yang:

    Backers collected more than 74,000 signatures to get the issue on this fall's ballot after efforts in the Republican-dominated state legislature went nowhere.

    Polls indicate it has a good shot at passing. For people like Robyn Page, it's more than just a political question.

  • Robyn Page:

    I wouldn't have to worry about letting a prescription run out for a couple weeks until I got the money to get it.

  • John Yang:

    And you do that now?

  • Robyn Page:


  • John Yang:

    Page is a substitute school teacher who spends most of her days caring for her quadriplegic son, Jonathan. She has diabetes, high cholesterol, chronic kidney disease, and a slew of other conditions that require daily medications.

  • Troy Landes, Terry Reilly Health Services:

    Let's take a little listen here to these arteries in your neck.

  • John Yang:

    Page and tens of thousands of other uninsured patients in Idaho rely on community health center clinics for reduced-cost primary care. But when it comes to specialty care, they're usually on their own.

    Donna Scranton hasn't worked for several years, since shortly after she began having mysterious seizure-like spasms. She sees a primary care physician at a community health center, but hasn't been able to see a specialist. So her condition has gone undiagnosed and untreated.

    Uninsured patients often end up in the emergency room, costing the state tens of millions of dollars each year.

    State Rep. Christy Perry, Idahoans for Healthcare Co-Chair: We're already providing it in the most costly way possible. And it's about just solving that solution in a way that is conservative.

  • John Yang:

    That's why Christy Perry, a conservative Republican state lawmaker, is co-chairing the Medicaid expansion campaign.

  • State Rep. Christy Perry:

    It's for people that need to have health care…

  • John Yang:

    Under the Affordable Care Act, the federal government pays at least 90 percent of the cost of expansion. Perry doesn't care that it's part of a law unpopular in Idaho. She says it's the fiscally responsible way to provide needed insurance coverage.

  • State Rep. Christy Perry:

    This doesn't have anything to do with the Affordable Care Act in the way that they look at it. They're relating it to Obamacare.

    I think what it is, Medicaid has been around since the 1960s. That is how we pay for indigent care in not only our state, but in this nation.

  • John Yang:

    Fred Birnbaum disagrees. He's the vice president of the libertarian Idaho Freedom Foundation, which opposes expansion. He argues it would shift funding from the truly needy to what he describes as able-bodied, working-age adults.

  • Fred Birnbaum, Idaho Freedom Foundation:

    One of the reasons it's been hard to repeal Obamacare is that states have been given this deal: If you expand Medicaid, the federal government will pick up 90 percent of the cost, the states 10. So states that have expanded, the 33, 34 states that have expanded, are hesitant to give up that deal.

    And I think we're at a fork in the road. If Idaho and Utah, Montana, Nebraska and other states expand Medicaid, it will be harder for Congress to reverse that.

  • Sen. Claire McCaskill, D-Mo.:

    But those who face cancer and many other illnesses have a preexisting condition when it comes to health coverage…

  • John Yang:

    Nationwide, Democrats are focusing on health care as they try to win back the House and Senate.

    According to the Wesleyan Media Project, nearly 55 percent of all midterm Democratic campaign ads have talked about it.

  • Paul Demko:

    Protections for preexisting conditions has become a huge issue…

  • John Yang:

    Paul Demko covers health care for Politico.

  • Paul Demko:

    They have really been back on their heels for the last four election cycles, getting bludgeoned by Republicans because of the shortcomings of Obamacare. And now the tables are kind of reversed, and they are — the law, the popularity of the law, among voters has improved. Especially as some of the popular provisions have been at risk of being taken away.

  • John Yang:

    Democrat Paulette Jordan believes the issue is boosting her uphill campaign to become the first female and the first Native American to govern this deeply Republican state.

  • Paulette Jordan:

    In rural Idaho, most of our folks are concerned with accessibility or even just affordability of health care.

    So now we have this opportunity to expand Medicaid. That would be very helpful not only to counter the indigent care costs, but allow folks to be covered. And then, on top of that, it would save our state money.

  • John Yang:

    Lieutenant Governor Brad Little, the Republican candidate who is heavily favored, has pledged to implement Medicaid expansion if it passes, but hasn't said how he will vote on the ballot initiative.

    We met Little, who is campaigning on the state's booming economy, at a Boise manufacturing plant where he serves on the board.

  • Lt. Gov. Brad Little, R-Idaho:

    we have to address these people in the gap. And I — I'm very committed to doing that. The question is, do we just do the categorical Medicaid expansion, like the other states, or do we do something else?

  • John Yang:

    Little argues that the ACA is responsible for driving up insurance costs, despite state efforts to make it work. Idaho was the only deep-red state to create and still run its own online exchange to help customers buy insurance under the Affordable Care Act.

    During next month's open enrollment, there will be at least three insurers offering plans. Many parts of the country will have just one.

    State officials estimate premiums have risen so much that as many as 40 percent of those seeking insurance on the individual market can't afford it.

  • Semele Freeman-Hall:

    Some of us have fallen through the cracks on this whole health insurance, health care… and I'm one of them.

  • John Yang:

    Among those priced out: Semele Freeman-Hall. The money she earns as a hair stylist in Boise and from selling real estate is too much to qualify for either expanded Medicaid or help with premiums under the ACA, but too little to afford them on her own.

  • Semele Freeman-Hall:

    If I made a decision between paying health insurance or buying food, is basically what it came down to.

  • John Yang:

    Premiums would be that high?

  • Semele Freeman-Hall:

    Yes. Yes.

    I think if they would come up with affordable plans, they probably wouldn't have to expand Medicaid.

  • John Yang:

    Nichole Stull and her husband, both independents with conservative leanings, are eager to vote for Medicaid expansion, but they're also taking a hard look at their options if it fails.

  • Nichole Stull:

    I was actually thinking about the stuff in our house. And we drive two old cars. I thought, 'OK, if we sold all of our possessions, we can afford health insurance for about a year.' And that's it, for a whole year. That would be — that would pay for premiums.

  • John Yang:

    On Election Day, they will be heading to the polls … and holding their breath.

    For the "PBS NewsHour," I'm John Yang in Boise, Idaho.

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