For anti-healthcare activists, the strategic options are starting to dwindle. Gutting the Affordable Care Act through the courts obviously isn't going to happen, and the odds of Congress repealing the law anytime soon are zero.
If the goal is to prevent ACA benefits from reaching more American consumers, the right can continue to fight against Medicaid expansion at the state level, but conservatives are quietly failing on this front, too, even in "red" states.
In April, Montana, hardly a bastion of liberalism, ignored the Koch-financed Americans for Prosperity and approved Medicaid expansion. Last week, Alaska Gov. Bill Walker (I) did the same. And just one day later, a deal was struck in Utah. The Salt Lake Tribune reported:
The so-called Gang of Six -- Gov. Gary Herbert, Lt. Gov. Spencer Cox, Senate President Wayne Niederhauser, House Speaker Greg Hughes, House Majority Leader Jim Dunnigan and Sen. Brian Shiozawa -- huddled this week constructing the skeleton of a new Medicaid plan to replace the governor's Healthy Utah and the House's Utah Cares proposals. On Friday, they announced their agreement, saying it was sustainable and would protect other key areas of the budget.
"There is still work to be done," Herbert said in a statement, "but I believe we now have a framework in place that will provide care for Utahns most in need while being responsible with limited taxpayer funds."
This puts Utah on track to become the 31st state to accept Medicaid expansion -- 32nd if we include the District of Columbia -- through "Obamacare." Estimates vary, but roughly 120,000 low-income Utahans are expected to gain coverage through the compromise agreement, assuming the Obama administration signs off on the deal.
If this sounds vaguely familiar, Utah's Republican governor announced a related plan two years ago, which would have brought Medicaid expansion to the state, but which was ultimately derailed by far-right lawmakers in the state House.
Officials are reportedly far more optimistic about this new effort, thanks in part to buy-in from the Republican state House Speaker and the Republican state House Majority Leader.
As for the bigger picture, what we discussed last week holds true: conservatives should prepare for similar 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.
States can only hurt themselves on purpose for so long before the madness ends.
It Utah is state #31, which state will be #32? Keep a close eye on Idaho.