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Monday, October 22, 2018


Knowing that Republicans would not have much interest in covering the estimated 15 percent of Americans who lack health insurance, the creators of the Affordable Care Act put both a “carrot” and a “stick” in the law to compel red states to offer more of their residents Medicaid.

The “carrot” was the federal government agreeing to pay 100 percent of the cost of expanding Medicaid to 133 percent of the poverty level at first and bring that percentage down to 90 percent by 2020. Currently the government pays on average 57 percent of the cost of Medicaid. So states could cover hundreds of thousands more residents, driving down the costs of those who rely on emergency rooms, while paying just a bit more than they currently contribute.

The “stick” was that the federal government could withdraw all Medicaid funding if a state rejected expansion. As the Supreme Court ruled that Obamacare’s individual mandate was Constitutional, it also decided that the “stick” was unconstitutional.

All the federal government had was the “carrot” to get Republicans to cover the 17 million uninsured the law was designed to help. And that mostly hasn’t been good enough. Wisconsin’s Scott Walker is even using the law as a chance to kick more than 80,000 Wisconsinites off the state’s Medicaid plan. As a result of this Republican recalcitrance, the Rand Corporation estimates that 19,000 Americans could die unnecessarily every year.

But a few “pro-life” Republican governors have actually recognized that the “carrot” is a great deal that their state will be paying for, even if they don’t accept it. Here are five Republican governors who have fought for Obamacare’s Medicaid expansion in their states. (See if you can guess what they all — except one — have in common.)