The Republican gains this week carried through to the state level as well. In terms of Governors, the breakdown shook out to 31 R and 18 D (Alaska is yet to be decided) which is 3 more than the Republicans previously held. In statehouses across the country, Republicans won 10 chambers which resulted in more splits in power rather than complete control. At this point it looks like 30 legislatures are republican led, 11 democrat led, and 7 are split (Colorado remains undecided). What does this mean for Medicaid expansion in the states? Not a whole lot. Getting Medicaid expansion done in those states that have yet to do so will remain an uphill battle. Anti-expansion incumbents in Georgia, Wisconsin, Kansas, and Maine won re-election. In Florida, where the Governor has quietly expressed some support in the past, the conservative legislature actively opposes expansion. Arkansas advocates will have the challenge of securing a ¾ vote for the annual reauthorization of their “Private Option” with a more conservative governor and legislature. There is some speculation with the new Governor in Pennsylvania that down the road the state might go with a more streamlined expansion. However, currently they are working on implementing the waiver that CMS recently approved which includes premiums and incentives for healthy behaviors and job training. The best hope for Medicaid expansion may be in Alaska where the Governor’s race is undecided but the challenger has expressed his willingness to expand. Several conservative states considering Medicaid expansion remained basically unaffected by the elections so some progress could be made now that elections are over in Indiana, Utah, Tennessee, Wyoming and possibly North Carolina.