The Medicaid Expansion Rock Rolls Part of the Way Back Down the Hill

Every time a Republican governor reaches a deal with the Obama administration on Medicaid “reforms” that enable him or her to accept the Affordable Care Act’s expansion of Medicaid eligibility, and the overwhelmingly generous federal dollar allocation that comes with it, you can almost feel the commentariat–MSM types but also progressives–sigh with relief that the inevitable is finally happening. I’m always a lot more skeptical about such phenomena, believing that ideology is thicker than dollars for a lot of the decision-makers in question. But even I thought Mike Pence’s Medicaid deal might make a difference elsewhere.

Maybe not so much, according to an update from Abby Goodnough of the New York Times:

In Tennessee and Wyoming…bills to extend Medicaid to far more low-income residents under the law were quashed by Republican legislators last week, despite having the support of the states’ Republican governors. Opponents in both states said that, among other things, they did not believe the federal government would keep its promise of paying at least 90 percent of the cost of expanding the program. It currently pays the full cost, but the law reduces the federal share to 90 percent — a permanent obligation, it says — by 2020.

“I learned that some feelings about the federal government here run deeper than practical economics,” said State Senator Michael Von Flatern of Wyoming, a Republican who sponsored the Medicaid expansion bill that failed there on Friday.

Yeah, that’s pretty much the point I’ve been trying to make all along.

Next up is Utah, where Gov. Gary R. Herbert, also a Republican, has negotiated a tentative deal with the Obama administration for an alternative Medicaid expansion but is meeting with resistance in his state’s Republican-controlled Legislature.

Vegas doesn’t give odds on these sort of things, but if it did, I suspect the odds of Utah expanding Medicaid have gone down significantly during the last week, if only because the often-sighted “big mo” has again faded into the mists.

There is good news in one state, Pennsylvania, where Tom Corbett’s efforts to come up with a deal that would satisfy both the Obama administration and conservatives who hate Medicaid have been abandoned. But that’s because he got removed from office by voters in November, and his Democratic successor, Tom Wolf, is pursuing a straightforward Medicaid expansion.

Adjusting to this new reality, Greg Sargent makes the excellent point today that we are heading towards a very serious polarization of the states in terms of health care coverage–a polarization that could get a lot worse if SCOTUS strikes down Obamacare subsidies for states with federally created health insurance purchasing exchanges. This, of course, is the kind of “federalism” conservatives claim to favor, except when they don’t.

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.