GOP Governors Shifting on Medicaid Expansion

Change is in the air as the staunch opposition to a key feature of the Affordable Care Act is wavering. New Jersey governor Chris Christie is the latest in a series of Republican governors who have recently ended their opposition to the Medicaid expansion provision. This change was facilitated by hospitals and healthcare providers who have been heavily lobbying the governors to expand Medicaid. The shift of position by key governors is splintering previously uniform resistance to Obamacare.

An important feature of the Affordable Care Act, expanding health insurance under the Medicaid program is one of two main ways the law will provide coverage to those who currently lack it. Starting in 2014, the law broadens Medicaid to cover everyone close to the Federal Poverty line. If all states were to participate in the Medicaid expansion, it would to cover 17 million Americans by 2022.

The hospital lobby’s forceful urging of governors to accept the Medicaid expansion is in hopes of saving billions of dollars in uncompensated hospital care covering the millions of people who currently lack insurance. The providers also had accepted billions in cuts to healthcare reimbursements, believing they would benefit from the millions of newly insured patients through Medicaid.

This is a major turnaround for some governors like Arizona’s Jan Brewer and Michigan’s Rick Snyder who came out strongly against accepting federal monies and expanding the Medicaid program in their states. The change in position hints that the lure of federal dollars might halt stiff Republican opposition to healthcare overhaul, with political expediency trumping philosophy. Now 22 states and the District of Columbia are on board, with another 17 other states thinking about accepting the expansion. The remaining 11 states, all having Republican governors, have continued to resist the expansion.

Medicaid MapMedicaid expansion map courtesy of The Advisory Board Company

Political risk comes with accepting any part of Obamacare in red states because the conservative base remains opposed to it. Being open to the Medicaid expansion could harm governors seeking re-election in conservative states, as recently demonstrated in Arizona. Because Gov. Brewer was so strongly against taking Medicaid money for Arizona, a Wall Street Journal’s editorial recently described her and other switching governors as “Obamacare Flippers.” Republican governors initially opposed the expansion philosophically, but then claimed that they did not want their states on the hook for Medicaid costs if the federal government stopped funding the expansion. The Obama administration has made a huge effort to reassure governors that upcoming budget reductions will not derail the program. “Medicaid cuts for this president are not on the table,” White House senior economic adviser Gene Sperling has stated.

Click here to read a commentary in Forbes, here to read more in the Washington Post, and here to read more in the Los Angeles Times.

NJ Governor Chris Christie, image © Bob Jagendorf / Wikimedia