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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

March 31: Opposition to Medicaid Expansion: It’s Not the Money, It’s the Ideology

There was a brief flurry of excitement this week about the possibility of more states accepting the Affordable Care Act’s Medicaid expansion. I poured some cold water on the idea at New York:

The train wreck involving the American Health Care Act in the U.S. House last week offered a burst of fresh hope to those in the 19 states that have not yet accepted the Medicaid expansion authorized by the Affordable Care Act and made optional by the U.S. Supreme Court. Most versions of GOP health legislation have canceled the expansion and its generous federal funding with variations in terms of speed and ferocity. The version of AHCA that slipped and fell while approaching the House floor contained a flat prohibition on any new expansions, reportedly at the behest of the House Freedom Caucus.

Coincidentally or not, early this week a coalition of Democrats and moderate Republicans in the Kansas legislature sent conservative governor Sam Brownback a bill designed to make that state the 32nd to expand Medicaid eligibility to poor people without children or disabilities…. But alas for any sense of momentum for Medicaid expansions, Brownback promptly vetoed the legislation, with a message that should remind everyone that rejection of the expansion has often been about ideology rather than money:

“I am vetoing this expansion of ObamaCare because it fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty, and burdens the state budget with unrestrainable entitlement costs.

“Most grievously, this legislation funnels more taxpayer dollars to Planned Parenthood and the abortion industry. From its infancy, the state of Kansas has affirmed the dignity and equality of each human life. I will not support this legislation that continues to fund organizations that undermine a culture of life.”

Alrighty then!

Vox has just conducted a quick survey of the non-expansion states and didn’t find much new activity despite some optimistic talk from expansion proponents. Virginia governor Terry McAuliffe has launched a new Medicaid-expansion campaign, but unless Democrats make gains in the legislature he will continue to be blocked. In Maine a ballot initiative has already been certified for November of this year to force an expansion that Governor Paul LePage has bitterly opposed.

There’s some mysterious talk in Georgia about Governor Nathan Deal’s administration approaching former Georgia congressman and now HHS Secretary Tom Price for “major changes” to the Medicaid program. Under HHS’ previous management, this might have been an allusion to one of those deals the Obama administration encouraged whereby states were given waivers to conduct conservative policy experiments with the entire Medicaid program in exchange for grudgingly accepting expansion and the massive federal funding that accompanied it. Since the Trump administration doesn’t support the expansion in the first place, it’s unlikely that it will be interested in bribing additional states into going along. It’s more likely Georgia will seek and perhaps receive permission to do unpleasant things to the existing Medicaid population.

All in all, the AHCA fiasco removed a big new disincentive to additional Medicaid expansions. But it didn’t remove the determination of conservatives in many states to reject free money to achieve better health coverage on grounds that it would benefit the undeserving, or make government too popular. That’s a forever thing.

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