Even though conservatives want to resist Obamacare implementation in any way they can, nine of 30 Republican governors have pushed for their states to participate in Obamacare’s Medicaid expansion. It looks like that number is about to rise to 10.
According to various publications including Politics PA, Pennsylvania Gov. Tom Corbett (R) will announce on Monday a plan for his state to expand Medicaid. The federal government will pay for 100% of the cost of expanded Medicaid until 2016 and then 90% thereafter. Generally, expanded Medicaid will cover people with family incomes up to 133% of the poverty level; people with higher incomes will buy subsidized coverage through Obamacare exchanges.
Corbett, like other Republican governors, is in a tough position. Conservatives are obsessed with blocking Obamacare and they don’t want states to participate in any way, even if the federal government will pay substantially all the costs. But when Republican state officials decline to participate, they will have to explain to both medical providers and potential Medicaid beneficiaries that they turned down free federal money just to spite the president.
The hospital situation will become especially untenable in 2014. The federal government will cut so-called “disproportionate share” payments to hospitals that are meant to compensate them for treating the uninsured, because the Medicaid expansion should reduce the number of uninsured patients. Without added Medicaid payments to offset the reduced disproportionate share payments, some hospitals will close. And Medicaid-blocking Republicans will take the blame.
Some Republican officials, like Gov. Jan Brewer (R-Ariz.), have been smart enough to understand this dynamic and decided to take some political hits now to have an easier 2014. Others, like Gov. Scott Walker (Wisc.) and Gov. Bobby Jindal (La.) have blocked the expansion, pleasing the conservative base now but setting them up for political problems down the road. Walker, in particular, has relied on a very narrow political coalition to secure his and his Republican legislature’s victories. Declining Medicaid expansion will give Democrats a powerful political issue against him in 2014.*
Corbett, who faces his own uphill battle for re-election, seems to understand that he can’t afford to take the blame for needless hospital closures next year. The remaining question is whether Republicans in the state House of Representatives will allow him to move to safer political ground.
*The situation in Wisconsin is more complicated than in most states and less politically perilous for Walker than I thought. Walker and his Republican legislature passed a plan that uses a patchwork of the state’s BadgerCare Medicaid program and federal exchanges in lieu of taking the full federal Medicaid expansion. This entails added costs to state taxpayers because the federal government will not pay as large a share of the cost of Medicaid coverage. But it shouldn’t markedly increase the share of the population that is uninsured, as in most states that reject the expansion.