State Speaker of the House, Thom Tillis, prepares to answer questions during a live televised roundtable Tuesday, Oct. 21, 2014 at Time Warner Cable News studios in Raleigh, N.C.
Travis Long/The News & Observer/AP

NC’s Tillis reconsiders Medicaid expansion

In North Carolina last night, Senate hopeful Thom Tillis (R) had the stage to himself, participating in a sole “debate” after Sen. Kay Hagan (D) chose not to participate, citing a scheduling conflict.
Alone on the stage, however, the Republican made a little news.
Asked if he thought it would be likely that the state legislature would expand Medicaid coverage after refusing to do so previously, Tillis said it might make sense once the state has better control of the financing of the program, which is notorious for its cost overruns.
He said he didn’t have an ideological objection to expanding the coverage. But he said when the state auditor told the previous governor that money was being wasted on it, the appropriate response would not have been to make it bigger and more costly.
“I would encourage the state legislature and governor to consider it if they’re completely convinced they now have the situation under control,” Tillis said.
On its face, that may not seem especially noteworthy, especially since plenty of other state Republican officials nationwide have already embraced Medicaid expansion under the Affordable Care Act.
The twist in this case, however, is considering what Tillis said about this issue before.
Greg Sargent reported back in April:
“Thom Tillis has a proven record of fighting against Obamacare. Tillis stopped Obamacare’s Medicaid expansion cold. It’s not happening in North Carolina, and it’s because of Thom Tillis.”
The expected GOP Senate nominee for North Carolina is boasting, in effect, that he is the sole reason 500,000 people in the state he would represent will not get health coverage under the Medicaid expansion. This quote comes from a radio ad Tillis ran this week in the GOP Senate primary.
In the larger context, there are a couple of takeaways here. The first is, the politics of health care have clearly changed to such a degree that Republican Senate candidates in tough races, even in the South, find that moving closer to “Obamacare” is the politically smart thing to do. This isn’t what the political world expected when the year got underway.
The second, as Ohio’s John Kasich (R) reminded us yesterday, is that opposition to Medicaid expansion under the Affordable Care Act is increasingly indefensible, even among very conservative Republicans.