When the Supreme Court ruled in June 2012 that individual states could decide whether or not to accept new federal funding to expand Medicaid, it changed health care politics. The Affordable Care Act’s architects had envisioned a big role for Medicaid – fully half of all uninsured Americans would qualify for the program, if every state expanded their offerings. But even though the federal government is slated to pay for almost all of the cost, partisan wars have raged in the states about whether to accept the expansion. As of mid-2014, two dozen largely Republican-led states have so far refused to expand their Medicaid programs.
Although the states largely split on partisan lines, some states with GOP governors or Republican legislative majorities have agreed to expand Medicaid – and more such states may yet do so. The new politics of health care are creating divisions in forces in and around the GOP.
Consider America’s best-known business association, the Chamber of Commerce. In many states, Chambers have lent their considerable clout to forces pushing for Medicaid expansion. As my data show, although Chambers of Commerce in 24 states have stayed on the sidelines, Chambers in another 24 states have publicly come out in support of Medicaid expansion. Ironically, in several states, such as Arizona and Missouri, Chambers have actually waged high-profile campaigns to lobby GOP-led legislatures for Medicaid expansion even while continuing to decry the Affordable Care Act overall.
Given that neither the national Chamber nor its state affiliates are known for supporting President Obama or boosting Democratic initiatives, why is this happening? I am still looking into the factors at work, but three stand out so far.
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