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.)
Arizona’s Jan Brewer
Governor Jan Brewer (R-AZ) was angling to be President Obama’s arch-enemy for much of his first term. She’s spent much of his second term making his signature legislative accomplishment her signature legislative accomplishment.
When her state’s Republicans refused to expand Medicaid, she called for a moratorium on any new legislation until it passed. She backed up her threat with five vetoes.
This week, her party gave in and made Arizona the 23rd state to accept expansion. As a result, 240,000 Arizonians who are poor but earn too much to currently qualify for Medicaid will have health care coverage, shielding them from financial ruin and improving their mental health.
AP Photo/Haraz N. Ghanbari
Michigan’s Rick Snyder
The bland Governor Rick Snyder (R-MI) became one of the least popular governors in America when he supported a union-busting measure passed without debate by a lame-duck legislature. Recognizing that he had only months to prepare for re-election in a state President Obama won by nearly 10 percent, Snyder decided to push for Medicaid expansion.
He, like Brewer, was rebuffed. Republicans pushed a compromise that would cap coverage at two years that state Democrats rejected. Finally the House passed a bill that expanded Medicaid on Thursday night by a vote of 76-31. The bill still needs to pass the state’s Senate to cover 400,000 Michiganders, but the chances are good.
Tea Party activists are now vowing to sit out of Snyder’s re-election campaign.
AP Photo/Paul Sancya
Ohio’s John Kasich
Governor John Kasich (R-OH) went there.
When his state’s Republicans refused to expand Medicaid, the former congressman and Fox News host played the Reagan card:
What would Ronald Reagan do?” That’s the litmus test many Americans rightly apply to political decisions nearly a quarter-century after he left office. Given the high regard I have for the former president, it should be no surprise that I’ve asked myself that question before.
[Reagan] also expanded Medicaid, not just once, but several times.
For example, in 1986, President Reagan let states add poor children and pregnant women to Medicaid. And after learning that disabled children could receive Medicaid care only in hospitals and nursing homes, he let states provide them care at home also. Ohio resisted both expansions for a decade but saw powerful results for some of our most vulnerable citizens once we made them.
MSNBC’s Steve Benen doesn’t think even this will be good enough. Ohio’s Republicans are displaying an obstinacy that dozens of red states flaunt, turning down billions that would stimulate their economy and costing their residents health care they deserve. “When a party’s elected officials are willing to take this kind of hit, on purpose, just because they really hate the president, they’ve let partisanship override good judgment to a remarkable degree,” Benen writes.
Florida’s Rick Scott
There’s a reason that Governor Rick Scott (R-FL) is the state chief executive most likely to lose his job next November.
After years of enraging the left by turning down money for high-speed rail, hiding a tuberculosis outbreak and purposely making it difficult to vote, Scott decided to push for Medicaid expansion. But he pushed just enough to alienate his right wing and that’s just about it. Unlike Brewer, the former health care executive wasn’t willing or able to use his power to make the right thing happen.
Photo: Gage Skidmore via Flickr.com
Nevada’s Brian Sandoval
With $16 billion in funding and insurance for 78,000 working Nevadans, Sandoval said, “All in all, it makes the best sense for the state to opt in,” even though he opposed Obamacare. The governor was also one of only five Republicans to agree to set up his own state health care exchange. Despite attacks that the federal government is “taking over” the health care system, the other 25 Republican governors decided to hand their marketplaces over to big government.
No Republican has done more to implement Obamacare, except maybe one man…
Okay, Mitt Romney didn’t actually fight for Obamacare. But he did invent it. Romneycare and Obamacare aren’t exactly the same, of course. The Massachusetts plan covers gay couples and abortion.
And the one thing all of the governors — except Jan Brewer — who fought for Obamacare have in common?
They all live in states President Obama won. Elections, you might say, are the ultimate “stick.”
AP Photo/Chris O’Meara