A Fresh Burst of Medicaid Expansion Backlash

The CW on the provisions of the Affordable Care Act expanding Medicaid at federal expense, famously made voluntary by the U.S. Supreme Court, has always been that the fiscal and moral logic of free money for expanded health coverage would be too compelling to pass up even for conservative Republican governors and state legislators, who would also be under intense pressure from health care providers in their states. It’s safe to say that assumption (which for the record I never shared) was drastically wrong, at least during the first round of state decisions on Medicaid expansion.

But recently there’s been evidence of a thaw in state-level Republican resistance to the idea of a Medicaid expansion, so long as the Obama administration continues to go the extra mile in giving states waivers to mess around with Medicaid generally in exchange for accepting the free money. And so the CW has resumed its old confidence; soon an expanded Medicaid will be pretty much everywhere, right?

Well, maybe not. As Politico‘s Sarah Wheaton reports today, Republican state-level gains in this last midterm election have created counter-pressure that could not only halt any emerging trend towards acceptance of the Medicaid expansion, but could actually roll it back in states that have already adopted it.

A handful of Republican governors said that after the November elections, they’d be open to taking billions of federal dollars to cover millions of their low-income residents under the Affordable Care Act Medicaid expansion. Instead, Medicaid faces possible retrenchment after a Republican tide swept emboldened Obamacare foes into every level of government.

Arizona and Arkansas, for instance, seemed like the top trophies in the expansion push. But the governors who embraced that part of Obamacare are gone, and hundreds of thousands of people could be stripped of their coverage if their successors don’t show the same zeal to defend it.

And the handful of Republican governors who are eyeing some form of expansion face roadblocks. For instance, Mike Pence of Indiana, a potential 2016 presidential contender, is attaching conservative policy elements unacceptable to the Obama administration. His potential 2016 rival John Kasich did expand Medicaid in Ohio but now must whip Republican support to keep it going. The governors of Tennessee, Utah and Wyoming all released proposals, as promised, after the elections. But so far in the two Western states, legislators are balking at taking on any part of Obamacare, even if the feds pick up the tab.

When it comes to today’s Republican Party, you should never, ever underestimate the raw power of ideology or the visceral appeal of opposing anything proposed by the devil-figure Barack Obama. Aside from the Medicaid expansion debate, that’s worth keeping in mind when it comes to the GOP’s reaction to a potential Supreme Court decision invalidating Obamacare subsidies in 36 states. Absent careful nudging and considerable education, many Republicans simply may not be able to help themselves when given an opportunity to hurt people by taking away government benefits. It’s kinda what some of them are in politics to do.

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.