Pence Wins or Caves on Medicaid, Depending on How You Look At It

I have to admit, this surprised me:

Indiana on Tuesday announced plans to expand Medicaid under the Affordable Care Act after securing concessions from the Obama administration that could pave the way for other Republican-led states to widen health coverage for low-income residents.

Gov. Mike Pence is the latest Republican to opt into the health law’s expansion of Medicaid despite his party’s opposition to the legislation. His move could prompt up to a half-dozen other GOP-led states to follow suit, including Florida, Tennessee and Alabama, by giving them a model to follow. Under Indiana’s agreement, the state can require some Medicaid enrollees to contribute toward their care.

If I’m not mistaken, HHS had in early negotiations already agreed to let Indiana use the state’s distinctive conservative health policy pet rock, Health Savings Accounts, in providing insurance to some Medicaid beneficiaries, along with the usual “personal responsibility” stuff, which will now include copayments and premiums and restricted access to ERs. Pence also got significantly increased reimbursements for hospitals, which is a pretty good indicator which health care lobby was most behind the move.

It remains to be seen if Indiana’s “deal” will become a template for other Republican-governed states, or will instead encourage them to make new demands.

In the meantime, this isn’t going over very well among conservatives. The Washington Examiner‘s Philip Klein did not mince words:

Indiana Gov. Mike Pence was known as a stalwart fighter for limited government principles as a member of the House of Representatives (one of few Republicans to have voted against President Bush’s Medicare prescription drug plan and No Child Left Behind law). But on Tuesday, he betrayed taxpayers when he embraced an expansion of Medicaid through President Obama’s healthcare law.

Pence argues that his expansion of Medicaid is actually a victory for market-based principles because of concessions he won from the Obama administration providing the state more flexibility over the implementation of the program. But this is merely window dressing. Any plan that expands the Medicaid program imposes more costs on taxpayers, expands the federal role in healthcare and should be passionately opposed by those who care about the nation’s future. The Congressional Budget Office, in its latest report, said that the federal government will be spending $920 billion over a decade expanding Medicaid through Obamacare.

As I wrote in May when Pence first proposed an alternative expansion, ultimately Pence buckled under pressure from hospital lobbyists who are eager to receive more federal money through the expansion.

And here’s the kicker:

The decision to expand Medicaid should damage Pence’s prospects as a candidate for the 2016 Republican presidential nomination, as it will be harder for him to win back the trust of conservatives who he has already angered by his embrace of Common Core.

Pence had drawn fire from the right for helping usher Indiana out of the Common Core education standards agreement, but then substituting nearly identical state standards.

Yeah, I doubt Pence is going to run for president now. Worse than anything emanating from Beltway conservatives was this statement from the Indiana state director of Americans for Prosperity, the flagship organization of the Koch political empire:

Chase Downham, Indiana state director of Americans for Prosperity, said he agrees that Medicaid needs to be overhauled but that “should not come at the cost of expanding an already troubled entitlement program to include hundreds of thousands of able-bodied, working-aged, childless adults.”

“Hoosiers believe in the dignity of work and desire the prosperity that comes with a job opportunity, not more government-funded health care,” Downham said.

Pence’s close relationship with the Kochs–and particularly with Americans for Prosperity– was thought to be one of his advantages if he did run for president. If he’s lost them, he ain’t all that.

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.