More than 2.7 million people could be added to the Medicaid program following next week’s election.

Avalere made that prediction in a new examination released  Tuesday. The firm noted that 14 of the 36 states holding gubernatorial elections this month have yet to expand Medicaid. Six have been labeled as “toss up” races by the Cook Political Report, and could seek to expand if the Democratic candidate wins.

“In states with competitive gubernatorial races, many candidates are making Medicaid expansion a key differentiator,” Elizabeth Carpenter, senior vice president at Avalere, said. “Depending on the election results, we could see Medicaid expansion on the agenda again in states across the country.”  

Florida, Georgia, Kansas, Maine and Wisconsin are all considering expansion, which would add 2.4 million people to the Medicaid rolls. That worries long-term care providers relying on Medicaid, as they cite added competition for funding as potentially leading to nursing homes closing.

Wisconsin long-term care facilities are struggling to retain staff, citing low Medicaid rates as the reason they can’t pay more to attract talent. Several facilities in Maine have closed this year, also citing a lack of reimbursement as a reason.

Another three states — Idaho, Nebraska and Utah — also have ballot referenda, asking voters to weigh in on Medicaid expansion. If voters in all three said “yes,” that could add another 325,000 enrollees to the program in 2019, noted Avalere. The firm used polling and health insurance market survey data to reach its conclusions.