One premise or hope of ACA supporters has been the belief that once new access to health care had been extended it would be politically difficult or even impossible to claw it back. This is the political logic which has guarded Medicare and Social Security for decades.
We still don’t know yet whether it will apply with Obamacare. But one thing that has become very clear in recent weeks is the political logic of Republican controlled states refusing Medicaid expansion. Given how little money states’ have to contribute, even over the long haul, there’s very little financial logic to refusing Medicaid expansion. This is why even a significant number of Republican governors eventually bought in. The reasons for opposing were ideological and political. Refusing Medicaid expansion would be a state by state (de facto and legal) nullification which would prevent the ACA from embedding itself in significant parts of the country. Refusing to establish exchanges was a similar gambit. But refusing Medicaid expansion was far, far more consequential.
We’re seeing how correct, if highly cynical, that political logic was.
One of the big, big parts of the Senate story is Republican governors who have not wanted to give up Medicaid expansion. We see it with Governor Sandoval in Nevada, Governor Kasich in Ohio as well as a number others. They are exerting major pressure on and in some cases provide cover for their senators. This also applies to some Republican senators from red states who nonetheless have Democratic governors and accepted Medicaid expansion. Louisiana is an example of that.
This isn’t a great surprise and it’s no great insight. But we’re seeing the dynamic play out in real time, in very hard, concrete ways. States’ unwillingness to give up Medicaid expansion has been a major problem for the Republican senate trying to repeal Obamacare. Whether it will be enough of an obstacle isn’t yet clear.
