Scott and Jindal Go Over the Brink on Medicaid Expansion

In the continuing campaign for the mantle of America’s Worst Governor, Florida’s Rick Scott and Louisiana’s Bobby Jindal became the first of their peers to put aside coy equivocation and flatly say they would oppose implementation of the Affordable Care Act’s Medicaid expansion provisions.

A statement on Scott’s official web page indicates that Florida just can’t afford the deal that health experts have almost universally called “impossible to turn down:”

[E]ven though the federal government has promised to initially pay 100% of the increase in Medicaid payments for the first three years of ObamaCare, the burden increasingly shifts to Florida taxpayers in future years.

Yeah, all the way to 10% of the costs. What a back-breaker! Where would a guy like Scott come up with money for corporate “economic development” subsidies and private-school vouchers?

Meanwhile, Bobby Jindal went over the brink on “Meet the Press” yesterday:

Every governor’s got two critical decisions to make….One is do we set up these exchanges. And, secondly, do we expand Medicaid. And, no, in Louisiana, we’re not doing either one of those things.

The reality is that pols like Scott and Jindal are using the supposed fiscal burden of the Medicaid expansion–or of any move towards covering the uninsured–as a fig leaf for their ideological opposition to the very idea. If the feds were offering to pay 100% of the cost, or 110% of the cost, the answer would be the same.

I know, I know, it’s widely thought to be incontrovertible that logic, pressure from providers, and the sheer idiocy of states with stingy Medicaid programs turning down a massive redistribution of resources in their favor, will all convince Republican governors to go along with the Medicaid expansion after they kick and scream for the benefit of “the base.” Perhaps that’s true, and that the rhetoric is the latter-day equivalent of the “massive resistance” southern lawmakers pledged to wage against the federally-imposed demise of Jim Crow.

But as the civil rights precedent showed, the competitive pressure of demagoguery is sometimes a lot more powerful than the “business logic” of going along with a more rational course of action. Now that Scott and Jindal have thrown down the gauntlet, can Nikki Haley or Scott Walker or Rick Perry or Sam Brownback be far behind?

This is of more than academic interest since the design of ACA really does depend on Medicaid expansion. In states where Medicaid fails to cover those under the federal poverty line, there are potentially millions of people who will not qualify for the subsidies available to higher-income families participating in the health exchanges.

So anyone who cares about covering the uninsured would be well advised not to count on hospital lobbyists to bring Republican state lawmakers to their senses.

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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.