Prominent conservative activists and groups have told Republican governors, more than once, in no uncertain terms, not to implement the Affordable Care Act. There are federal laws that are not optional, but when it comes to creating exchanges and expanding Medicaid, the right hasn't been subtle: their future prospects in GOP politics will be dependent on their resisting "Obamacare."
To their credit, some of these governor don't seem to care.
Idaho Gov. C.L. "Butch" Otter (R) announced Tuesday that, pending approval of the state legislature, Idaho will build a health insurance exchange as stipulated by Obamcare.Otter made clear that the decision is not an endorsement of the law, arguing in a press release that the decision would mean Idaho would create the exchange rather than having the federal government do it for the state.
In a statement, Otter said, "This decision does not signal support for the law or how it is being implemented. However, it does reflect my continued determination for Idaho to be actively engaged in making the best possible choices -- to the degree we are allowed -- in the interest of more accessible and affordable health care for our citizens."
The right doesn't want to hear this, but for Otter, this should be -- and is -- a no-brainer. Either Idaho sets up its own health care exchange or Republicans invite federal control over how the state system will be structured. Love the law or hate it, governors have an incentive to take advantage of controlling their own insurance options, rather than leaving it to Washington.
In the case of exchanges, there really isn't much of a point to putting up a fight, anyway -- they were, after all, a Republican idea in the first place.
And yet, we still have plenty of GOP governors balking, with New Jersey Gov. Chris Christie (R) becoming the latest last week. Why is Christie refusing to create his own exchange? Probably because he has national ambitions, and is afraid of primary ads that accuse him of cooperating with the law Republicans have been told to hate.
It's infinitely easier to respect the policy decisions of governors who put patients over politics. Otter is doing the smart thing, as is Nevada's Brian Sandoval.
Gov. Brian Sandoval (R-NV) told the Associated Press on Tuesday that he plans to accept Obamacare's optional expansion of the Medicaid program to extend coverage to additional low-income residents in his state. Sandoval is the first Republican governor to commit to expanding Medicaid, as GOP leaders across the country have continued to resist that crucial provision of the health care reform law despite several reports confirming the economic benefits to Obamacare's proposed Medicaid expansion.The governor acknowledged that even though he remains a staunch opponent to the Affordable Care Act, expanding the eligibility level for Nevada's Medicaid program will help tens of thousands of people who would not otherwise been able to access health coverage. About 22 percent of his residents are currently uninsured, and participating in the Medicaid expansion will allow Nevada to add 78,000 low-income residents to its Medicaid rolls: "All in all, it makes the best sense for the state to opt in," he said.
In Texas, meanwhile, Medicaid expansion is also the obvious, responsible thing to do, but Gov. Rick Perry (R) refuses to even consider it, for reasons that only seem to make sense to him. Democrats in the state legislature hope to go around the governor, appealing to state Republicans' sense of fiscal responsibility -- state Sen. Rodney Ellis (D) said fiscal conservatives have an incentive to reach an agreement "because the alternative is going to cost us much more economically and dig a much deeper hole in our budget."