• The health care law. In four states — Alabama, Florida, Montana and Wyoming — ballot measures sought to block the Affordable Care Act‘s individual mandate, which requires people to sign up for health insurance, or else pay a small penalty, starting in 2014. (That year, the penalty will be $95 for an adult and up to $285 or 1 percent of a family’s income, according to this U.S. News analysis.) The referendums passed in every state except Florida, but the Supreme Court’s decision in July to uphold the mandate rendered them all moot. Another anti-Obamacare measure that passed was Missouri’s Proposition E. It requires the state’s governor to obtain approval from state legislators or directly from voters before instituting one of the statewide insurance exchanges envisioned by Obamacare, which would allow individuals and small businesses to shop for the least expensive health insurance online.
• End-of-life decisions. By a narrow 51 to 49 percent tally, Massachusetts voters rejected Question 2, which would have legalized physician-assisted suicide for terminally ill patients. The opposition included “religious, medical and disability rights groups,” the Boston Globe reported. Those groups outspent proponents 5 to 1. Only Washington and Oregon have legalized assisted suicide, and 34 states have passed statutes banning it. Six others, including Massachusetts, have legal precedents blocking the practice.
• Protecting Medicaid. Louisiana passed Amendment 1, which now bars state officials from tapping into the Medicaid Trust Fund for the Elderly to reduce state budget deficits. Voters in South Dakota, in contrast, rejected Measure 15, which would have increased the state’s sales tax and other levies to fund Medicaid and education.
• Voter ID. In Minnesota, voters rejected a constitutional amendment that would have required residents to produce a photo ID before they could vote in future elections. While proponents argue that such laws prevent electoral fraud, critics say that they disproportionately hinder the elderly from voting.

—Patrick J. Kiger

An AARP analysis of the exit poll data shows that while the 50+ vote went to GOP candidate Mitt Romney by 53-46 percent, older voters played an important role in Obama’s decisive near-sweep of battleground states.

See also: State-by-state breakdowns of the 50+ vote at the AARP Election 2012 Center.

According to Associated Press results on Wednesday afternoon, Obama racked up at least 303 electoral votes; the outcome in Florida, which has 29 electoral votes, remains unclear (Obama appears to have a lead of fewer than 50,000 in the state). The popular vote was much closer, with the president winning slightly more than 51 percent, compared with just under 49 percent for GOP candidate Mitt Romney. About 2.75 million votes separate Obama and Romney, out of 117.89 million cast. It was a slight dropoff for Obama, who in 2008 won 365 electoral votes and 52.9 percent of the popular vote.

According to an AARP  analysis, voters age 50 and older made up 44 percent of the electorate this year, a 1 percent increase from four years ago. Voters age 50 to 64 accounted for 28 percent of this year’s turnout; those 65 and older accounted for 16 percent.

Obama didn’t do as well election night with 50+ voters, winning about 2 percent less of that age group than he did in 2008. While Obama lost older voters by only two percentage points to John McCain in 2008, he lost the group to Romney by a seven-point margin. Voters age 50-64 went for Romney by a 52-47 margin, while Romney trounced the president in the 65-and-older demographic, 56-44.

Even so, there are so many older Americans that they accounted for a bigger portion of Obama’s support than any other age demographic, casting nearly 4o percent of his vote total.  The 24 million votes for Obama by 50+ voters nearly doubled what he got from 18- to 29-year-olds, the group in which Obama is overwhelmingly popular.

Even more important, Obama actually won the 50+ vote in three crucial states.

• Iowa: In the bellwether midwestern state, older voters amount to 54 percent of the electorate. Obama won those voters by 53-46 over Romney, the mirror opposite of how he performed with older voters nationwide. In all, 50+ voters provided Obama with half of his six-point victory margin in Iowa.
• Wisconsin: In this state, older voters amount to 53 percent of the electorate. Obama again prevailed  51-48, achieving the same vote percentage that he got from all age groups nationwide. Older voters contributed one percentage point to Obama’s seven-point victory in the state.
• New Hampshire:  Romney’s hopes of claiming the state next door to his home state of Massachusetts were extinguished by older voters, who make up 46 percent of New Hampshire’s electorate. They broke for Obama by 52-48 and contributed two points to Obama’s five-point margin.

Why older voters flocked so strongly to Obama in those three crucial states is a harder question to answer. He didn’t do as well with their counterparts in Pennsylvania and Ohio, where Romney won the 50+ vote by eight and six points, respectively.

A Kaiser Family Foundation poll released Oct. 31 showed that Obama held a narrow advantage among likely voters on determining the future of the Medicare and Medicaid programs.

—Patrick J. Kiger

But that doesn’t mean that issues especially important to voters 50 and older will stay the same.

With the nation’s looming fiscal problems, Social Security, Medicare and Medicaid could face changes. And President Obama’s signature accomplishment — the Affordable Care Act — now faces the implementation phase (instead of a prospective battle over repealing it had Republican Mitt Romney had been elected).

Medicare and Social Security wouldn’t be affected by the approaching fiscal cliff, the fallout from last year’s failed budget negotiations. And advocates for older Americans, including AARP, continue to argue that it should stay that way. The programs’ long-term funding imbalances — more boomers are using both programs and health care costs rise faster than inflation — deserve to be sorted out separately, not mixed in with deficit issues, they say.

But as lawmakers and Obama scramble to come up with a budget deal before the end of the year, both programs could indeed be swept into the larger battle over federal spending as the nation struggles with its deficit. Discussions are likely to include such major changes as raising the eligibility age for Medicare to 67 and changing the way Social Security cost-of-living adjustments are calculated.

Like Medicare, the health care law faced the possibility of much further-reaching change if Romney had won. But it, too, faces new challenges in the coming months.

Some Republican stalwarts in Congress will continue to try to chisel off pieces of health care reform, but odds are higher that the reform will largely stay intact. That means people on Medicare will get help with prescription drug expenses that once fell into a “doughnut hole” without coverage, preexisting conditions will be covered and, starting in 2014, individuals will be required to have insurance or pay a penalty.

Some states have watched from the sidelines, waiting to see who won the presidential race. With the health care law here to stay, those states are faced with two big decisions:

• whether to expand access to Medicaid, using new funds from the law.
• whether to set up insurance exchanges to help those who want to buy coverage, or cede that power to the federal government.

In a victory speech in the wee hours of Thursday morning, Obama said: “we are not as divided as our politics suggest.”

Some of the issues most important to older voters are the ones that will test that premise. —Tamara Lytle

Photo: Saul Loeb/AFP/Getty Images

From Kaiser Health News

The Republican Party retains control of the House of Representatives, despite the Democrats’ Medicare attacks. As a result, House Republicans could continue to clash with President Obama and the Senate’s Democratic majority.

The Wall Street Journal: GOP Retains House Control
Republicans retained control of the House Tuesday night, confronting President Barack Obama with a continuing partisan obstacle to his second-term agenda (Hook, Nov. 7).

The New York Times: Republicans Stand Firm in Controlling the House
Retirements by a large number of Democratic members, and a message on Medicare that more or less fizzled, were additional impediments. Blue Dog Democrats, a group of moderates whose numbers have been dwindling, were particularly endangered as they struggled to defend districts they had long held. . . . There appeared to be no single issue that Democrats could turn to their advantage, like the health care debate that so dominated the 2010 Congressional elections and propelled Republicans back into the majority (Steinhauer, Nov. 7).

The Associated Press: Republicans Renew House Control For Two More Years
Shortly after Obama’s reelection was clear, Boehner — reelected without opposition — said voters had conveyed a desire for compromise. That was a departure from the House GOP’s general tone over the past two years . . . Even so, the prospects of continued gridlock over major issues remained strong, both because of the GOP’s strong conservative bent and because Boehner has sometimes faced challenges shepherding his rank-and-file members to endorse deals he’s wanted to strike. Earlier in the evening, he seemed more combative (Fram, Nov. 7).

In the meantime, a key Democrat in health care — chairman of the Ways and Means health subcommittee — was defeated by another Democrat.

Reuters: California’s Longest-Serving Congressman Ousted After 40 Years
Rep. Pete Stark, the cantankerous dean of California’s congressional delegation, appeared to lose his bid for a 21st straight term after being swept aside by a fellow Democrat 50 years his junior. But he was perhaps best known for his relentless push for nationalized health care, and he played a minor role in writing the Affordable Care Act of 2010 (Shih, Nov. 7).

Politico: Pete Stark Defeated After 40 Years in Congress
The 20-term Democrat lost to fellow Democrat Eric Swalwell 53.1 percent to 46.9 percent, with 100 percent of the vote calculated in the 15th district in California, according to the Associated Press. Stark built a reputation as a hard-charging advocate for progressive health reform in Washington, but in recent years was bogged down by a record of gaffes and personal insults to his colleagues. Not even the endorsements of President Barack Obama and House Democratic leader Nancy Pelosi could overcome Swalwell’s message to San Francisco Bay voters: that the 80-year-old Stark has been in Washington way too long (Haberkorn, Nov. 7).

Finally, a Georgia Democrat who stood against the health law won reelection and a New York Democrat, who won last year by opposing Rep. Paul Ryan’s Medicare plan, lost.

The Atlanta Journal-Constitution: Democrat Barrow Holds Off Challenge; Other Georgia Incumbents Win Easily
U.S. Rep. John Barrow, the last white Democrat in the House from the Deep South, won reelection Tuesday in one of the more closely watched congressional elections in the nation. . . . Barrow highlighted how he has often bucked his own party, underscoring his vote against the federal health care legislation and the fact that he often voted with Republican House Majority Leader Eric Cantor (Redmon, Nov. 6).

The Hill: Rep. Hochul Falls in New York
Rep. Kathy Hochul (D-N.Y.)] had taken advantage of the controversial Medicare overhaul that Rep. Paul Ryan (R-Wis.), the GOP vice presidential nominee this year, had included in the House budget. Her victory and campaign had energized Democrats, and fed some speculation that Ryan’s inclusion on the ticket this year could make Medicare a central issue of the presidential campaign (Becker, Nov. 7).

Each entry in both posts included excerpts from — and links to — stories about these races by local and national news organizations. (For more background on the races, as well as links to the AARP Voters’ Guide for each contest, see the Oct. 24 post.)

Here’s a state-by-state rundown of who won and who lost on Nov. 6 — with the winner in bold — in each of the 12 key Senate races, with breakdowns of the 50-plus vote, where available, from exit polls. Democrats won 10 of the races; Republicans won two.

ARIZONA

Republican Jeff Flake, who’s currently in the House of Representatives, defeated Democrat Richard Carmona, a physician and former U.S. Surgeon General in the Bush administration, in his bid to succeed Republican incumbent John Kyl, who’s retiring.

Breakdown: Flake 50 percent, Carmona 45 percent. In exit polls, Flake carried voters age 50-64 by 51-39 percent and voters age 65+ by 62-36 percent.

CONNECTICUT

Democrat Chris Murphy, who’s currently in the House of Representatives, defeated Republican Linda McMahon to fill the seat being vacated by independent Sen. Joe Lieberman, who’s retiring.

Breakdown: Murphy 55 percent, McMahon 43 percent (with 88 percent of the vote counted). In exit polls, Murphy carried voters age 50-64 by 42-46 percent and voters age 65+ by 54-43 percent.

FLORIDA

Democratic Sen. Bill Nelson, the incumbent, turned back a challenge from Republican Rep. Connie Mack IV.

Breakdown: Nelson 55 percent, Mack 42 percent. In exit polls, Nelson carried voters age 50-64 by 55-43 percent and voters age 65+ by 50-48 percent.

INDIANA

Democrat Joe Donnelly, who’s currently in the House, defeated Republican Richard Mourdock, the state’s treasurer, in his bid for the seat of outgoing Sen. Richard Lugar, whom Mourdock defeated in the GOP primary.

Breakdown: Donnelly 50 percent, Mourdock 44 percent. In exit polls, Mourdock carried voters age 50-64 by 48-47 percent and voters age 65+ by 55-42 percent.

MASSACHUSETTS

Democrat Elizabeth Warren, a law professor and consumer activist, unseated Republican Sen. Scott Brown, who won a special election in 2010 to fill the seat of the late Democratic Sen. Ted Kennedy.

Breakdown: Warren 54 percent, Brown 46 percent (with 95 percent of the vote counted). In exit polls, Warren carried voters age 50-64 by 56-44 percent and voters age 65+ by 53-47 percent.

President Barack Obama’s reelection ensures the survival of his landmark health care law, but predominantly Republican state officials will get a big say in how it is carried out.

State lawmakers will control whether millions of uninsured people get coverage through Medicaid beginning in 2014, as the law envisions. They’ll also decide whether to set up online markets where individuals can shop for coverage and seek federal subsidies to lower their costs.

Next year, at least 30 states will be led by Republican governors, and many will also have Republican-controlled legislatures. Still, most analysts believe the president’s victory will prod the nearly three dozen states — both Republican and Democratic — that have been reluctant to move forward.

“Red states and undecided states [will] reconsider what they have been saying and doing the past few months,” said John Poelman, senior director of Leavitt Partners, a consulting firm advising states on carrying out the law, citing pressure from consumers, hospitals and other providers to expand coverage.

States have considerable sway over how the law is carried out because the Supreme Court gave them the power to reject the expansion of Medicaid, which had been expected to cover more than half of the 30 million people gaining health insurance under the law.

Since the court’s decision, six Republican governors in Texas, Florida, Mississippi, South Carolina, Louisiana and Georgia have said they will not participate, even though the federal government would cover the costs of new enrollees through 2016 and at least 90 percent thereafter.

If those governors follow through, they could significantly undermine the law’s goal of extending coverage to uninsured Americans.

Most analysts are betting that won’t be the case, however, because billions in newly available federal subsidies and intense lobbying by health providers and consumers will spur most states to reassess their positions. The most recalcitrant, such as Texas and Florida, may opt out initially.

“Not all states will expand Medicaid in 2014, but within a couple of years, all of them will have,” Poelman predicted. “That’s similar to what happened when Medicaid began in 1965. The program did not start in every state initially, but nearly all had it by 1970. Arizona was the last state to add the program in 1982.”

State Lawmakers Weigh In

State lawmakers will also play a key role in deciding whether to expand Medicaid when they convene this winter and next spring.

“When state legislatures are back in session, we expect a flurry of attention to what the states will do,” said Richard Cauchi, health program director for the National Conference of State Legislatures.

Mike Fasano, a Republican and one of the longest-serving Florida lawmakers, said with the president’s win, the GOP-dominated state legislature would “take a hard look” at expanding Medicaid — despite the opposition of Republican Gov. Rick Scott.

Fasano, who is moving from the state Senate to the state House next year, said Florida can’t afford to miss out on new revenue without having its own plan to help more than 4 million residents who lack health insurance.

He acknowledged that challenging Scott would be an uphill battle but said the governor’s waning popularity might embolden lawmakers.

Officials in other states insist they will opt out of the Medicaid expansion regardless of the election outcome. “An Obama victory won’t change our strategy,” said Tony Keck, Medicaid director of South Carolina, although he acknowledged it might spur questions from the Republican-controlled state legislature.

Keck said the only way state officials might consider expanding the program is if they can scale back eligibility and benefits and require Medicaid recipients to pay more for their care — requirements the Obama administration has generally opposed.

Sandy Praeger, Kansas’ insurance commissioner and past president of National Association of Insurance Commissioners, expects many states to attempt to negotiate smaller Medicaid expansions than called for in the law.

Some, for instance, might propose expanding coverage to people who make up to 100 percent of the federal poverty level ($23,050 for a family of four), instead of the 133 percent ($31,000 for a family of four) required by the law. A more limited expansion would be cheaper for states that will have to start paying some of the bill in 2017. The administration has yet to say whether states can do a partial expansion.

Deadlines Loom on Exchanges

The first battles are likely to be over the health law’s new insurance exchanges, which are supposed to make it easier to find an affordable plan and to help people in small group and individual insurance markets determine if they qualify for new federal subsidies.

States have to give federal regulators a plan by Nov. 16 detailing how they will move forward with their own exchanges, with enrollment slated to launch next October. Under the law, the federal government would set up exchanges where states don’t.

As of late September, only 19 had begun setting up exchanges or agreed to do so in partnership with the federal government, according to an analysis by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

“It certainly will matter who is in the governor’s office for how states will approach the decision” on exchanges, said Alan Weil, executive director of the National Academy of State Health Policy.

He noted that after Republican governors won in Maine and Wisconsin in 2011, both put the brakes on efforts to implement the law, which had been started by their Democratic predecessors.

But some governors who are worried about the costs are also concerned that if the federal government steps in, they may lose control over their insurance markets, said Krista Drobac, director of the health division at the National Governors Association.

Whether states that have stood on the sidelines until now can meet the tight deadlines to have the exchanges running by late next year is an open question. That timeline is also likely to be a challenge for the federal government, which will have to review hundreds of insurance plans if it sets up the marketplaces in dozens of states. Consumers in federally operated exchanges may initially have fewer choices than in those run by states.

Praeger expects that Kansas and other previously undecided states will agree to partner with the federal government to move forward.

“I expect to see a lot of activity between now and Nov. 16,” she said. “States will look at this more pragmatically to keep their options open.”

President Barack Obama’s victory cements the Affordable Care Act, expanding coverage to millions but leaving weighty questions about how to pay for it and other care to be delivered to an increasingly unhealthy, aging population.

Democrat Joe Donnelly beat Tea Party Republican Richard Mourdock, giving Democrats a needed pickup to keep their Senate majority. But 50- to 64-year-olds, who represent 29 percent of the state’s electorate, narrowly went for Mourdock, going for the Republican 48-47 percent. Among 65-and-older voters, Donnelly fared even worse, capturing just 42 percent of that vote, compared with 55 percent for Mourdock, according to exit polls. The retirement-age group accounts for 14 percent of the electorate in Indiana. President Obama racked up similar numbers among 50+ voters, taking 47 percent of the 50- to 64-year-old age bracket (against 51 percent for Republican Mitt Romney), and earning 44 percent of the 65-and-older vote, compared with 51 percent for Romney.

During the campaign, Donnelly hammered Mourdock for his commitment to retirement programs, citing an earlier speech when Mourdock suggested Social Security and Medicare were unconstitutional. Mourdock said his comments were taken out of context.

—Susan Milligan