With the 2014 election results in, Republicans will soon occupy the governor’s mansion in 31 of the 50 states. Republicans won governor races in traditionally “blue” states such as Massachusetts, Maryland, and Illinois. Tom Corbett of Pennsylvania was the only Republican governor to be defeated.

In Vermont, incumbent Gov. Peter Shumlin (D) received the most votes, but not a majority of those cast, as required by state law. The predominantly Democratic General Assembly will determine the winner in January.

Republicans also took control of 11 state legislative chambers, bringing their control of state legislatures to a total of 29 states. In 11 states, Democrats have the edge in the state legislature; control is split in 8 states and undecided in 1 state (Colorado). However, the Democratic Party was able to hold majorities in the both the Iowa Senate and the Kentucky House. Finally, Republicans now also control 27 Attorney General offices, which is up from the preelection tally of 25.

Ballot measures
On the ballot front, California voters soundly rejected two propositions that would have had a significant impact on health care. Proposition 45 would have given the state insurance commissioner the power to reject health insurance rate hikes for about 6 million Californians who buy their own policies or who work for small businesses. Proposition 46 would have raised the state’s 39-year-old cap on medical malpractice damage awards, required doctors to take random drug tests, and mandated use of a database designed to reduce prescription drug abuse.

South Dakota approved a ballot initiative supporting the “any willing provider” option. This requires health insurers to treat as in-network any healthcare provider who is willing and qualified and who meets conditions for participation established by a health plan. This measure was supported by specialty hospitals and the South Dakota State Medical Association and strongly opposed by health insurers and business groups.

North Dakota voters rejected a measure that would have repealed a requirement that majority ownership in a pharmacy be held by a registered pharmacist, while Louisiana voters approved two measures that create Medicaid and hospital stabilization funds. Other state ballot measures considered included legalizing marijuana, requiring labeling of genetically modified foods, background checks on gun purchases, and minimum wage hikes.

Medicaid expansion
The election results will leave state Medicaid expansion decisions largely unchanged. Opponents of Medicaid expansion, including Scott Walker in Wisconsin, Rick Scott in Florida (who officially backed expansion but did little to persuade the legislature), Nathan Deal in Georgia, Paul LePage in Maine (who vetoed expansion five times and got 10 percent more of the vote than he did 4 years ago), and Sam Brownback in Kansas, were all reelected.

Those states are not expected to reverse course and expand Medicaid anytime soon, particularly since they all have Republican legislatures hostile to anything that smacks of Obamacare. Republican governors newly elected in states that did expand Medicaid—Bruce Rauner in Illinois and Doug Ducey in Arizona—have said they will leave the expansion more-or-less intact, and Larry Hogan (a businessman who pulled off a stunning upset in Maryland) did not declare his priorities.

The conservative states that already had been eying various forms of expansion—including Utah, Indiana, Tennessee, and North Carolina—were relatively unaffected by the elections. For example, Tennessee Gov. Bill Haslam won by 70 percent amid his public efforts to find a compromise.

Other Republican governors who won reelection included Michigan Gov. Rick Snyder, Ohio Gov. John Kasich, New Mexico Gov. Susana Martinez, and Nevada Gov. Brian Sandoval, who coasted to a second term with 70 percent of the vote.

Elizabeth Fassbender is the communications specialist in the AAOS office of government relations; Kristen Brackemyre is the staff manager for the Orthopaedic Political Action Committee.