Repeal is off the table. That’s what Sen. Dean Heller (R-NV) has concluded. As Jennifer Haberkorn and Jason Millman of Politico reported on February 5:
I think it’s a decision that the governor [Brian Sandoval] had to make and the governor alone had to make it,” Heller said. “I do support the decision he made, which he believes is best for the state of Nevada.” But it’s not like all politics are suddenly being cast aside. Conservative health policy wonks have picked apart the GOP governors’ decisions to implement the health law, and The Wall Street Journal editorial page this week labeled them the “Obamacare Flippers.”
So far, most states led by Democratic governors have chosen to run their own health insurance exchange and expand Medicaid to cover many more low-income and working-poor individuals and families.
Only three Republican governors are pursuing state-run exchanges: Nevada, New Mexico and Idaho. And so far, five Republican governors are pursuing a Medicaid expansion: Nevada, New Mexico, Arizona, Ohio and North Dakota. Almost half of the nation’s governors remain undecided on the Medicaid expansion — including a few big states such as Michigan and Florida.
Utah may do a partial implementation — having an exchange that serves small businesses, but letting the feds create one for individuals.
The GOP governors all made clear that they didn’t make the decisions lightly. “In deciding to expand Medicaid, I weighed every possible outcome and impact,” [Gov. Susana]Martinez [R-NM] said. “Ultimately, this decision comes down to what is best for New Mexicans.”
Their biggest fear is that the federal government is going to cut back on the funding they promised — 100 percent for the first three years, gradually scaling back to 90 percent. Like many other governors, Martinez warned she’d drop the expansion if the feds retreat. “If the federal reimbursement rate for Medicaid expansion is cut, we must protect our kids and protect our budget by ensuring that the most recent additions to the Medicaid program are the first ones moved off,” she said.
New Mexico, along with Nevada and Arizona, were the first three Republican-led states to support the Medicaid expansion, and they have striking similarities. The states have high rates of uninsured people and large Hispanic populations, which strongly supported Obama in 2012.
Gov. John Kasich of Ohio is another defector, who decided to agree to the terms of the Medicaid expansion in Obama’s health care law. As Philip Klein of the Washington Examiner wrote on February 4, “his [Kasich's] decision, a huge victory for the White House that will provide cover for more Republican governors to do the same, serves as a great case study on how difficult it is to impede the growth of government.”
Klein noted how Kasich liked to say that he was a member of the Tea Party before it existed, but those sentiments weren’t present today when he announced that this expansion is good for Ohioans. In fact, Klein noted that this move by the governor was “political cowardice” for not being able to rein in public sector unions. He faces re-election in 2014. I think we see where his motivations came from with this shift.
I’m thinking conservatives need to revisit Avik Roy’s column on Medicaid he wrote for Forbes in March of 2011. It’s a program he called “a humanitarian catastrophe.” Why?
University of Virginia that found that surgical patients on Medicaid are 13 percent more likely to die than those without insurance of any kind. The study evaluated 893,658 major surgical operations from around the country from 2003 to 2007, andnormalized the results for age, gender, income, geographic region, operation, and 30 background diseases.
Despite all of these adjustments, surgical patients on Medicaid were nearly twice as likely to die before leaving the hospital than those with private insurance.
Patients on Medicare were 45% more likely to die than those with private insurance; the uninsured were 74% more likely; and Medicaid patients 93% more likely. That is to say, despite the fact that we will soon spend more than $500 billion a year on Medicaid, Medicaid beneficiaries, on average, fared worse than those with no insurance at all.
This is, simply put, the greatest scandal in America. Bigger than Madoff, bigger than the Wall Street bailout, bigger even than the plight of the uninsured.
For all of TARP’s flaws, the government actually made money—$22 billion—bailing out the banks. For Medicaid, in contrast, we spend nearly half a trillion dollars every year to provide the poor with worse care than is gained by the uninsured.
So, some Republicans are cool with expanding a policy that kills more people than it saves. It’s one of the most costliest provisions in the Affordable Care Act, and a few Republican governors are signing on for the ride. Nevertheless, the reality that he simply don’t have the money for it will soon percolate through – and the Tea Party will be waiting.