About two months ago, Nevada's Republican governor, Brian Sandoval, did something no other Republican governor in the country had done: he endorsed President Obama's Medicaid expansion plan. While clearly the right move on policy grounds, Sandoval's decision was a political surprise -- conservative groups have made it abundantly clear to GOP governors that activists on the right consider this policy an outrageous betrayal of conservative principles that would not be tolerated.
It took a month for Sandoval to get some company, but New Mexico's Republican governor, Susana Martinez, ended up endorsing Medicaid expansion, too. A few days later, so did North Dakota Gov. Jack Dalrymple (R). Arizona Gov. Jan Brewer (R) grudgingly reached the same conclusion, as did Ohio Gov. John Kasich (R).
This week, Michigan's Rick Snyder became the sixth Republican in the club.
A day before he delivers his budget message to the state Legislature, Gov. Rick Snyder gave his unconditional support for an expansion of Medicaid to include about 450,000 more uninsured, low-income Michiganders into the program."We're all here to support expanding Medicaid," Snyder said at a news conference called by a coalition of groups that support the expansion. "This is very exciting today. We're moving forward with care for people who need it."The expansion will allow roughly 470,000 more uninsured low-income Michiganders to be covered by Medicaid.
This probably isn't a coincidence. Once some Republican governors took the plunge, it apparently led some of their GOP counterparts in other states to notice the water was fine. And just like that, a policy that Republican chief executives were supposed to avoid like the plague -- a policy that implements the dreaded "Obamacare" -- is no longer GOP anathema.
"The logjam has broken," Ron Pollack, executive director of Families USA, said. Bill Pierce, a former Health and Human Services official under George W. Bush, added, "It's a tipping point. You've now got a real conservative state, a battleground state and a blue state all signed up. If you're a Republican governor thinking about this, you fit into one of those categories."
However, for those who want to see more American be able to afford basic medical care, the news is not all good.
As Joan McCarter explained this week, Pennsylvania Gov. Tom Corbett (R), for reasons that defy comprehension, rejected Medicaid expansion in his state.
The Medicaid expansion would have provided coverage to 542,000 additional people in the state over the next decade, according to analysis from the Kaiser Family Foundation. That would have cost the state $2.8 billion over a decade, with the federal government kicking in $37.8 billion to the state. More than 1.3 million Pennsylvanians are uninsured, nearly 13 percent of the state's non-elderly population.Between Corbett's voter suppression and vote rigging schemes and his hard-right, destructive course on Obamacare, this blue state Republican might be making 2014 a bit of a challenge for himself. Here's something for Pennsylvania Democrats to consider: this decision is not irrevocable. States can decide to participate in the expansion at any point, though after 2016 the federal government won't pick up 100 percent of the tab.
Making matters worse, Indiana Gov. Mike Pence (R) also made the wrong call.
Gov. Mike Pence said Wednesday that he has ruled out expanding Medicaid under the federal health care law unless Indiana gets approval to use state health savings accounts for the expansion. [...]"It was important to me that we do fully fund Medicaid, but we did not fund a Medicaid expansion, nor do I think that under the current framework for Medicaid that it would be advisable for Indiana to do that," he said.
It's worth noting that the Indiana fight may not be completely over just yet. State legislators are still eyeing expansion, and some Republican lawmakers appear open to moving forward with legislation. State Senate Minority Leader Tim Lanane (D) emphasized Medicaid expansion in neighboring states, arguing, "I don’t think we ought to be known as the island of the uninsured."
While we wait to see what happens, it's still something of a relief to see a growing number of Republican governors do the right thing on this. To reiterate a point from the other day, the way the Affordable Care Act is structured, Medicaid expansion is a great deal for states, and should be a no-brainer for governors who care about lowering health care costs, insuring low-income families, improving state finances, and helping state hospitals.
The only reasons Republican governors would balk is if (a) they're afraid of their party's base; (b) they plan to run for president and don't want this to be used against them in a primary; or (c) they're bad at math; or (d) some combination therein.
As a practical matter, it's become something of a test: how many GOP governors value arithmetic over ideology? As of today, the number is six. Here's hoping it continues to grow.