Louisiana’s Democratic governor, John Bel Edwards, moved quickly to expand Medicaid when he took office in 2016, making his state the only one in the Deep South to embrace that signature piece of President Barack Obama’s health care law.

And in a conservative state that solidly supports President Donald Trump, the $3 billion-plus Medicaid expansion program that is Edwards’ hallmark achievement isn’t going anywhere, even if the Democratic governor is ousted by a Republican in this fall’s election.

Edwards’ two main challengers on the Oct. 12 ballot—U.S. Rep. Ralph Abraham and businessman Eddie Rispone—aren’t pledging to rip expansion out by the roots in a state where about 10% of residents get the coverage.

Instead, Edwards’ opponents strike at one of his primary selling points by slamming the administration’s rollout of Medicaid expansion rather than the program’s creation. The GOP contenders accuse Edwards’ health department of millions in wasteful spending and suggest they would tighten controls.

“They have to be careful in how they are framing their critique because it’s a popular program,” says Michael Henderson, director of LSU’s Public Policy Research Center.

Nearly 460,000 Louisiana adults—mainly the working poor and many of them voters—receive the government-financed health coverage. LSU’s annual survey of Louisiana public opinion shows 76% approval for Medicaid expansion, including 57% backing from Republicans.

To criticize Edwards on expansion, “you have to make a complicated argument that says, ‘Hey, I like this thing the governor did, but boy, I wish we’d done it differently. Let me do it differently,’” Henderson says. “That’s a tricky argument to make.”

In fundraising emails, Edwards says his Republican opponents “won’t hesitate to dismantle” the program if they win.

But Abraham and Rispone step gingerly when asked about plans for the expansion program, insisting they don’t want to kick anyone off the coverage if they qualify. 

Abraham and Rispone say Edwards mismanaged expansion, with rampant fraud and abuse. They cite legislative audits that documented money spent on ineligible services and that suggested millions may have been spent on people who earned too much for the coverage, including 1,600 people with six-figure incomes. Read the full analysis from The Associated Press.

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Louisiana governor election won’t uproot Medicaid expansion – Greater Baton Rouge Business Report