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

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 (ph), she runs a start-up
that produces videos for local companies. But she also finds yourself 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, Small Business Owner: 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. WOMAN: 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, Patient: 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: Yes. JOHN YANG: Page is a substitute school teacher
who spends most of her days caring for her quadriplegic son, Jonathan (ph). She has diabetes, high cholesterol, chronic
kidney disease, and a slew of other conditions that require daily medications. MAN: 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. CHRISTY PERRY (R), Idaho State Representative:
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. 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. 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), Missouri: 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. WOMAN: I will to fix Obamacare. PAUL DEMKO, Politico: 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 law among voters has improved, especially as some
of the popular provisions have been at risk of being taken away. JOHN YANG: Democrat ®MDNM¯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. ®MDNM¯PAULETTE JORDAN (D), Idaho Gubernatorial
Candidate: 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, Hairstylist: 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 hairstylist 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,

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