Listen to what the governor said Tuesday when asked the question. "You know I wouldn't say nudging toward it," said Bentley. "But we are certainly looking at that; not right now. We are not at that stage right now." But then the governor added this when asked about remarks he had just made to a group of seniors about the need to improve healthcare in rural areas and how Medicaid expansion might come into play: "But you know we do have to realistically look at whether we have adequate funding for rural doctors, primary care doctors. They cannot treat a third of their patients and stay in business. It is a business they run," said the governor.
State officials opposed to Medicaid expansion through the Affordable Care Act have always had a tough time rationalizing their ridiculous position. Lately, however, it's actually gotten worse.
States that refused to expand Medicaid under the Affordable Care Act are now paying the price, literally," TPM reported yesterday. "A new Kaiser Family Foundation report released last week suggests that the Republican-controlled non-expansion states are seeing their share of Medicaid costs rise more sharply than expansion states."
In other words, we're looking at Republican-run states paying more for less, on purpose, spiting themselves to satisfy partisan goals that only they care about.
Even Alabama is rethinking its obstinacy on the issue. The Alabama Media Group reported yesterday on Gov. Robert Bentley (R) possibly "nudging closer" to accepting Medicaid expansion through the ACA (thanks to my colleague Laura Conaway for the heads-up).
Well, yes, that's kind of the point. Alabama is facing a serious budget problem, and at the same time, rural medical facilities in the state are facing financial pressures that could close their doors. Medicaid expansion could go a long way in helping address both problems, all while extending coverage to thousands of low-income families.
The question, then, is whether Alabama wants to deal with its real-world challenges or prefers to hate "Obamacare" on principle.
The state's Republican governor added yesterday, "You know for the last few years we've been dealing with the Affordable Care Act. I was personally against the Affordable Care Act. I never called it Obamacare because it's not a person, it was a philosophy. But we lost folks. We lost. And we lost in court. So what we have to do now is move past that, take the resources we have available and try to improve the quality of life for the people of Alabama and that's exactly what I'm going to do."
This wasn't an explicit endorsement of accepting Medicaid expansion, but to my ear, it was close.
As for the bigger picture, 30 states have already adopted the Medicaid policy through the Affordable Care Act, though that list is likely to continue to grow. South Dakota is moving forward with a policy that would make it the 31st state on the list, and if John Bel Edwards wins his gubernatorial race this year, he intends to make Louisiana #32.
As we've discussed before, conservatives should prepare for more 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.