In it, but not of it. TPM DC
In the latest example, vociferous Obamacare critic and Texas Gov. Rick Perry is seeking roughly $100 million in federal funds under a program set up under Obamacare, called Community First Choice, to help states provide home-based health care to chronically ill Medicaid patients, as Politico reported this week.
Perry's office said Politico's story was "not accurate" and pointed TPM to a Texas Tribune article in which the governor's aides downplay the connection of the funds to Obamacare, and noted that what they're seeking is not the broader Medicaid expansion to extend eligibility to more low-income residents.
"The bottom line is it has nothing to do with Obamacare," said Perry spokeswoman Allison Castle.
Only it has everything to do with Obamacare. As the Department of Health and Human Services explained last February, the new Community First Choice program was explicitly set up under the Affordable Care Act and offers federal funds so states can pay a higher reimbursement rate to providers of home-based care. The aim was to ratchet back an incentive for ill patients to go to a nursing facility when they can be cared for at home.
Perry is in good company among Republican governors, many of whom want billions of federal funds under the law's Medicaid expansion, but don't want to call it Obamacare.
One example is Arizona's Jan Brewer, who used scorched-earth tactics to compel the reluctant Republicans who lead the state legislature to accept the eligibility expansion under Medicaid. After she won the fight, she insisted she was still against Obamacare and came up with her own name for what she had done.
"While I remain opposed to the Affordable Care Act, it has become increasingly clear to me that the status quo is not an option," Brewer said. Instead, the governor described the expansion as her own plan. "With my Medicaid Restoration Plan, we can continue providing cost-effective care to these individuals -- Arizona's working poor."
Another example is Florida's Rick Scott. He initially rejected the Medicaid expansion. But faced with pressure from hospitals, and an enticing offer to insure many of his uninsured residents on the federal government's tab, Scott buckled and championed the Obamacare provision back in February -- only to be thwarted by his Republican-led legislature.
Then he returned to criticizing Obamacare, papering over the Medicaid component.
"The president's health care law is a disaster. It's going to be bad for patients, it's going to be bad for businesses, it's going to be bad for providers. There's nobody that wins in that bill," Scott told the local News Radio 1620 in June.
Well, not nobody, he admitted, calling the Medicaid expansion a "compassionate, common sense step forward," rather then a "white flag of surrender to government-run health care."
The governors' desire to gloss over this contradiction reveals the contrast between Obamacare's fixture as a conservative bogeyman and the good that the law, flawed as it may be, stands to do for many Americans. The Medicaid expansion is a lucrative offer: states are permitted to enroll new residents up to 133 percent of the federal poverty line; Washington will cover the full cost of the new beneficiaries until 2017 and pay 90 percent thereafter.
Other Republican governors who backed the expansion, such as John Kasich of Ohio and Susana Martinez of New Mexico, downplayed its link to the Affordable Care Act when declaring their intentions. But governors like Tom Corbett of Pennsylvania and Mary Fallin of Oklahoma conspicuously stressed Obamacare when announcing they'd turn it down.
New Jersey Gov. Chris Christie, one of just four Republican governors to have officially enacted legislation expanding Medicaid, was more forthcoming and didn't deny that he was embracing a part of Obamacare, albeit reluctantly.
"Let me be clear, I am no fan of the Affordable Care Act," he said in a budget speech to the legislature back in February, announcing his support for the expansion. "I think it is wrong for New Jersey and for America. I fought against it and believe, in the long run, it will not achieve what it promises. However, it is now the law of the land. I will make all my judgments as governor based on what is best for New Jerseyans."
This week, Louisiana Gov. Bobby Jindal (R), also an outspoken Obamacare critic, reportedly pulled his request for funds under the law's Community First Choice program, the same one Perry is considering for his state, complaining that the Obama administration was not willing to be flexible.
"You can't rail against the Affordable Care Act at every opportunity and then clandestinely, selectively apply for different pieces of funding for it," Moriba Karamoko, who runs the Louisiana Consumer Healthcare Coalition, told Politico.