Cracks continue to develop in the Republican Party’s concrete opposition to Obamacare’s state expansions of Medicaid, the health insurance program for the poor.
Whether those fissures will crumble Medicaid opposition in Kansas and Missouri, though, remains very much in doubt.
On Wednesday, Gov. Rick Snyder of Michigan became the sixth GOP governor out of 30 to recommend expanding Medicaid eligibility in their state.
“This makes sense,” he said, “for the physical and fiscal health of Michigan.”
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And on Monday, Ohio Gov. John Kasich, another Republican, recommended Medicaid expansion in his state. An estimated 684,000 people would have new access to health coverage in Ohio, fully paid for by the federal government over the next three years, if Ohio lawmakers agree.
While those announcements appeared to weaken the GOP’s rock-solid resistance to Medicaid expansion, other Republican governors and conservatives stepped up their attacks on the idea this week.
Republican Gov. Tom Corbett of Pennsylvania rejected Medicaid expansion in his state Tuesday, claiming it would be too expensive “without serious reforms.”
Other Republican governors — Bobby Jindal of Louisiana and Rick Perry of Texas among them — have also said they want to turn down the federal money for more Medicaid.
And dozens of conservative writers blasted Kasich’s choice, calling it an improper, tacit endorsement of what they call Obamacare.
“Governors should be working to reduce dependence on the welfare state, not add millions more to it,” wrote Nina Owcharenko, a health policy analyst at the Heritage Foundation in Washington, D.C.
“The governor,” echoed the conservative National Review, “has allowed himself to be bought off by the false promise of ‘free money’ from the federal government.”
The Supreme Court said last summer that expanding Medicaid under the Affordable Care Act would be optional for states. Since then, every state has wrestled with the costs and benefits of extending Medicaid eligibility for millions of America’s working and non-working poor — those earning up to 133 percent of the federal poverty level.
While the first three years of expanded Medicaid will be paid for by Washington, states will eventually pick up part of the tab. By 2022, participating states must pay 10 percent of the cost of the expansion.
Expanding Medicaid is considered a key part of the health care act’s goal of insuring almost all Americans. To date, roughly half of all states have indicated some support for expanding Medicaid.
The back-and-forth over the wisdom of Medicaid expansion has not gone unnoticed in Kansas and Missouri.
Gov. Jay Nixon, a Missouri Democrat, referred favorably to Kasich’s decision this week while discussing his own efforts to expand Medicaid in his state. In earlier speeches, Nixon has referred to Gov. Jan Brewer of Arizona, another Republican governor who recently endorsed Medicaid expansion for her state.
Scott Rowson of the Missouri Health Advocacy Alliance said Republicans are starting to understand the cost benefits of Medicaid expansion, improving the chances for its passage in Missouri.
“We’re moving to a post-politics discussion,” he said. “Governors around the country are really looking now at what Medicaid expansion means on the ground.”
Nixon is expected in Independence this afternoon to make the Medicaid expansion argument. He’s contended, as have other governors, that the state-based cost of expansion will be paid for by taxes from jobs created to treat new Medicaid patients.
Still, few signs exist that Republicans in Missouri’s legislature are changing their views because of Medicaid decisions in other states.
“We will not follow the lead of out-of-touch bureaucrats whose reckless spending has pushed our nation to the brink of financial disaster,” Missouri House Speaker Tim Jones said last week.
John Hancock, a former Missouri GOP chairman and now a political consultant, said few legislators will care what other states decide to do about Medicaid.
“Every state is unique and has unique dynamics and unique relationships with the hospital community,” he said.
But Alan Rosenthal of Rutgers University, an expert on state legislatures, said GOP lawmakers in Missouri — facing pressure from rural hospitals and other providers who support expanding Medicaid — may find the Snyder and Kasich decisions helpful.
“The main effect politically is that other governors and legislators who are Republican get some cover,” he said in an email.
While other governors have announced their positions on the issue this week, Kansas Gov. Sam Brownback’s views remain unannounced.
Contacted this week, Brownback’s office did not provide a timetable for his decision.
Bob Beatty, a political science professor at Washburn University in Topeka, said he would be surprised if the GOP governor follows Snyder and recommends expanding the program.
“If Brownback does go with these other governors, he would be bucking the clear trend of his administration over the past couple of years,” he said.
Lobbyists for Medicaid expansion in Kansas have maintained a lower profile than in Missouri, where an organized political push for the program has been under way for weeks. But some health-care providers hope Brownback agrees with governors like Snyder.
Expanding Medicaid, they argue, could provide additional money for the state’s transition to KanCare, the privately managed Medicaid system.
“Governors in both parties are now really looking into this and seeing there is some benefit for their states,” said Cindy Samuelson of the Kansas Hospital Association.
Nicole Kaeding, state policy manager for the conservative Americans for Prosperity, expects an opposite outcome.
“Expanding Medicaid is exactly the wrong decision for a state to make,” she said, “including Kansas and Missouri.”