By skyforbes 
Key Findings
- Pete Ricketts won reelection by 19 points on November 8 and strongly opposed expansion of Medicaid as a provision of Obamacare. However, of the eight counties that voted in favor of Medicaid expansion, six of them voted for Ricketts.
- Despite these counties splitting their ticket with Medicaid and Ricketts, the vote was still partisan. Counties that strongly supported Ricketts were usually less likely to support Medicaid expansion, and counties that supported Medicaid expansion supported Ricketts less strongly.
Nebraska Governor, Pete Ricketts (R), is headed for another four years in Lincoln as the State’s Chief Executive. On November 8, Ricketts won in a landslide 19-point margin over his challenger, State Senator Bob Krist, a former Republican-turned-Democrat. Ricketts fell short in both Douglas and Lancaster County — home to the major cities Omaha and Lincoln, respectively, but made up the ground in landslide victories in rural parts of the state.
Also winning in last week’s midterm results is Initiative 427 — a ballot measure approved by Nebraska Voters that will expand Medicaid to an estimated 90,000 Nebraskans in low-income employment. The initiative passed more narrowly than Ricketts’ victory at roughly 7 points, but will now factor into the State’s budget.
Both the measure and Ricketts were not synonymous with each other. Ricketts long opposed expanding Medicaid as a measure of Obamacare, and the Republican-controlled Legislature refused to take up the issue in the past. The initiative was supported by the state’s Democratic Party including a handful of legislators and Krist (ironically the measure performed better than Krist in every county as well as better than the Senate candidate, Jane Raybould). However while Ricketts handily won reelection, many counties that supported him either supported the measure or came very close to voting in favor of it.
Nebraska is a red state. The Cornhusker States’ Presidential Partisan Lean* as of 2017 was 14 points more Republican than the nation altogether. Amongst its counties, Douglas and Lancaster County are the least Republican counties* with a partisan lean of “Even” (roughly 0). On the other end, Grant and Hayes County are both the most Republican counties in Nebraska at R+45 each (45 points more Republican than the nation).
Let’s start with a picture of the statewide vote. As many have noticed, it paints a sizeable urban-rural divide in the state despite its overall Republican lean. Eight Counties voted in favor of Medicaid Expansion with the most significant support coming from Douglas, Lancaster, and Thurston County, respectively. Medicaid Expansion won by roughly 44,000 votes and winning Douglas County by an estimated 49,000 votes was enough to put the measure over the top.
The initiative even won support in the Panhandle region of Nebraska, an arguably more conservative area than the Omaha metro with Scottsbluff and Dawes County voting in favor. However, Medicaid Expansion did not win a majority favor in the heartland of the State, glossing over cities such as Kearney, Grand Island, and Hastings as well as a variety of other towns and villages.
Overall six of the eight counties saw voters split their tickets between Pete Ricketts and Medicaid Expansion — Dakota, Sarpy, Thurston, Dawes, Scotts Bluff, and Burt County. Dakota and Sarpy were the closest counties in matching their support for both Medicaid and Ricketts with a 4.1% and 5.4% difference in the vote, respectively. Thurston County was the only one of the entire group that voted in favor of Medicaid Expansion more than Ricketts, but still supported the Governor. The three remaining counties, however, voted in disproportionate favor for Ricketts more than the Medicaid Expansion — passing with a difference of nearly 17 points in Scotts Bluff and Burt County, respectively. The difference in vote proves that Medicaid Expansion did not enjoy the coattails of Rickets’ victory across the State and had an uphill battle in very Republican regions.
To look at this in a different framework, let’s compare the margins that counties voted for Ricketts and Medicaid Expansion. Counties that supported Pete Ricketts by a substantial margin were usually less inclined to support Medicaid expansion whereas the counties more likely to vote for Medicaid typically supported Ricketts by a lesser margin. Grant County, one of the most Republican counties in the State supported Pete Ricketts with over a 70 point margin and voted against Medicaid by nearly a 40 point margin. Douglas and Lancaster County, meanwhile, voted against Ricketts and decisively in favor of Expansion by over 20 points. Counties on the fence such as Dodge and Box Butte voted for Ricketts but narrowly against Medicaid Expansion.
The significant outliers in this trend were Saline and Kimball counties — both in different regions of the state. Kimball County, located in the Panhandle region, voted heavily for Ricketts by over 60 points but voted against expansion by a narrow margin. Saline County, in the southeast region of the State, was the only county to vote the most narrowly for Governor Ricketts and Medicaid Expansion. The American Community Service estimates that Saline and Kimball County have an uninsured rate of 15.6% and 23.8%, respectively, which may have driven voters in Kimball more to vote for expansion and support Ricketts. Saline County voted for Barrack Obama narrowly in 2008 and maybe more supportive of Democratic initiatives than other Nebraska counties.
In the end, partisanship played a more significant role in the outcome of the vote than the possibility of obtaining health insurance. Pete Ricketts and every Republican running for Congress in Nebraska from Deb Fischer, Adrian Smith, Don Bacon, and Jeff Fortenberry opposed or avoided the matter entirely. Many Nebraska Democrats lined up on the other side to tout the benefits of expansion.
The World-Herald article wrote that Hayes and Thurston County are the highest uninsured counties in the state, but Thurston, ranked R+2 in partisan lean and home to two Indian reservations, voted 2–1 in favor while Hayes, ranked R+45 in partisan lean, voted against by nearly 50 points. In Grant County, residents rely heavily on Obamacare, but it is complicated by high premiums and deductibles, difficult access to healthcare facilities, and resentment to Government oversight in healthcare.
The data used in this analysis can be found here, and the visualizations created in this analysis can be found here for further interaction.
Thanks is deserved for the New York Times and Nebraska Secretary of State for supplying the data, and FiveThirtyEight for the inspiration in the Presidential Partisan Lean formula.
*Inspired by FiveThirtyEight’s old formula — Presidential Partisan Lean is a weighted average of the difference in how the state voted against the nation in 2012 and 2016. 2012 is weighted 25% and 2016 weighted 75%.
*Relative, of course.