Turning Point on Health Care? Not So Fast

Because of the close proximity of Rick Scott’s surprising decision to accept the Affordable Care Act’s Medicaid Expansion, and the appearance of the Holtz-Eakin/Roy strategy document for how Republicans can live with Obamacare (which I wrote about yesterday), there’s a temptation for progressives to declare big corners turned, as Jonathan Chait did today:

From the moment President Obama set out to reform the health-care system, Republican opposition was a Terminator robot driven by a boundless, remorseless determination to kill. Every single Republican in Congress opposed the bill, and Republicans who even considered supporting something vaguely like it were ruthlessly purged. Even after it was passed, Republicans ginned up far-fetched legal challenges, held endless votes to repeal it, and vowed not to implement it at the state level. They couldn’t be bargained with, couldn’t be reasoned with, and felt no pity.

The repeal machine has suffered a series of devastating blows — the Supreme Court upholding the individual mandate, Obama’s reelection, the decision of several Republican governors to accept the program’s expansion of Medicaid — and continued to lurch forward. But Governor Rick Scott’s announcement that he will enroll uninsured Floridians in Medicaid appears to be a real death blow, the moment the cyborg’s head is crushed in a steel press.

I dunno about that last part. Odds of an actual repeal of Obamacare evaporated on November 6, since there’s no realistic scenario where the president could be convinced to sign a repeal of his most important legacy legislation, or where Republicans could muster the votes to override a veto. As for the Medicaid expansion: It’s certainly a big turning point for the uninsured in Florida, assuming Republican legislators ratify Scott’s decision. But I see no particular reason to believe that Scott’s “betrayal of his conservative principles” is going to have any impact on Rick Perry, Nikki Haley, Nathan Deal, Phil Bryant, Robert Bentley, Mary Fallon, Paul Le Page, Mike Pence, or other Republican governors deciding or threatening to reject the expansion. They are mostly in better political shape than Scott, and all would regard stopping the Medicaid expansion as a career highlight and probably as a ticket to post-gubernatorial fame and fortune in the various precincts of wingnutland.

And while I agree the Holtz-Eakin/Roy document is a big deal, it by no means represents a strategy that today’s Medicaid refuseniks can’t seamlessly adopt. The whole approach is to use the health exchanges created under Obamacare as a wedge to gradually vitiate Medicare and Medicaid. Rejecting the Medicaid expansion is pretty obviously a big step in the same direction, since it would expand the operation of the exchanges in most states. The implementation of Obamacare, with various degrees of buy-in from the states and from Republicans, represents less a turning point in the battle than a change of landscape.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.