Surgical Tech Melissa Ellis prepares an OR room in the University of Mississippi Medical Center in Jackson, Mississippi, October 4, 2013. Mississippi is one of at least 20 states that has decided not to expand Medicaid under the Affordable Care Act.
Jonathan Bachman/Reuters

A poor choice for a litmus test

Updated
Republicans have a unique problem when it comes to Medicaid expansion. On the substance, it’s a no-brainer. On the politics, they want to oppose it anyway.
 
The result is an awkward tension with Republican Party politics. On the one hand, we see several conservative, red-state governors and policymakers – each of whom apparently enjoys access to calculators – acknowledging that Medicaid expansion is important for state finances, state economies, state hospitals, and low-income families. On the other, we see far-right voices responding, “Yeah, but Obamacare is bad and stuff.”
 
The next step in the evolution of this fight is watching the issue take center stage in Republican primaries. Last week, for example, there was a congressional special election in Louisiana featuring two Republican candidates, one of whom had the gall to say Medicaid expansion is sensible. He won easily anyway, but not before his GOP rival made this the central attack of the race.
 
A similar dynamic is unfolding in Idaho.
[T]he issue is now making its way into Idaho’s Second Congressional District – where what looks to be a brutal primary between Rep. Mike Simpson and a conservative challenger named Bryan Smith is already shaping up.
 
In a press release earlier today, The Club for Growth, a powerful fiscally conservative group, pointed out that a super PAC backing Simpson has also endorsed expansion. (It’s not clear where Simpson stands on the issue, and that’s sort of the point.)
 
Does Mike Simpson support or oppose expanding Medicaid under ObamaCare in Idaho, just as his supporters in the Idaho Association of Commerce and Industry do?” asked Club for Growth spokesman Barney Keller in the release.
Obviously, the smart answer would be, “Of course I support expanding Medicaid under Obamacare in Idaho,” but we know that if Mike Simpson says this out loud, the far right will pounce and attack ads will soon follow.
 
It’s easy to make the case that Simpson shouldn’t care – the attack ads certainly didn’t work in a conservative Louisiana district last week – but the point is the emergence of the latest litmus test in Republican politics. It’s not enough to criticize the Affordable Care Act and/or support repealing it; GOP candidates are expected to also condemn Medicaid expansion, no matter how sound a policy it is.
 
Indeed, as Greg Sargent explained yesterday, several far-right House lawmakers are even pushing to defund Medicaid expansion in order to increase defense spending. Greg added:
Democrats increasingly believe that, at a time when the law known as “Obamacare” is suffering serious rollout travails and is sinking in polls, the Medicaid expansion is a good issue for them – one that neatly shows that some of the individual provisions of the law remain politically viable, and as an added bonus could even divide Republicans.
 
Obamacare’s expansion of coverage is most pronounced in the Medicaid expansion area, which could make it politically more difficult over time for Republicans to oppose it – even as conservatives appear poised to continue making opposition to it a defining issue. Whether this emerges as a real wedge among Republicans will be something to keep watching.

Medicaid

A poor choice for a litmus test

Updated