As implementation of the Affordable Care Act has moved forward in recent years, anti-healthcare activists have recognized Congress' limits. Republicans on Capitol Hill would love nothing more than to derail the system, but with President Obama in office, that's not going to happen.
The right has instead focused on state-level fights, most notably Medicaid expansion through the ACA, which is a voluntary policy for governors and state legislators. If conservative groups and activists can persuade state-level Republicans to reject the policy, they can block "Obamacare" from reaching more people and prevent the uninsured rate from falling further.
And while this campaign has had some success, the wall of opposition continues to slowly crumble. This week, South Dakota's Republican governor became the latest to endorse Medicaid expansion. The Argus Leader reported:
Tens of thousands of low-income South Dakotans could gain access to subsidized health care plans if the federal government agrees to a plan by Gov. Dennis Daugaard. Daugaard announced a plan to expand Medicaid in the state Tuesday during an address to unveil the Republican governor's $4.8 billion budget plan.
South Dakota's legislature is dominated by a Republican majority, much of which is skeptical of the policy, so it's hardly a done deal. But the fact that yet another GOP governor in a ruby-red state has embraced the ACA policy is further evidence of a growing wave.
Indeed, last week, Wyoming Gov. Matt Mead (R), a former opponent of Medicaid expansion, also reversed course and endorsed the idea as a way of reducing his state's budget shortfall.
This follows Louisiana's latest steps towards adopting Medicaid expansion, and Alabama taking steps in the same direction.
And then there's Kentucky, the only state of the 30 that have already accepted Medicaid expansion that wants to move backwards. New Gov. Matt Bevin (R) had vowed to eliminate the policy altogether, but he's now clarifying that he envisions an Indiana-style approach to Medicaid expansion, which would leave much of the status quo intact.
The far-right governor apparently discovered taking health security away from thousands of his constituents is easier said than done.
As we've discussed before, conservatives should prepare for more defeats soon. There will no doubt be some holdouts and dead-enders, but the arithmetic and common sense can only be denied for so long.
Those who continue to argue that states should reject the policy out of partisan spite – regardless of the benefits for families, regardless of the needs of state hospitals, regardless of the effects on state finances – are facing headwinds that are only growing stronger.