The National Governors Association meeting came and went this weekend without any definitive answers on Medicaid expansion – from both sides of the political divide. Republicans continue to be either adamantly opposed to expanding Medicaid for their populations or undecided about the matter. And Democratic governors, for that matter, have not lined up in total support, either.
Of the country’s 20 Democratic governors (plus Independent Rhode Island Gov. Lincoln Chafee), 13 — and Chafee — plan to fully implement the national health-care law’s Medicaid expansion, while seven have yet to make up their minds, USA Today reported earlier this week.
So what does the chairman of the Democratic Governors Association make of the fact that in more than half a dozen states, Democratic governors are waiting to make a decision on whether they’ll implement a key aspect of President Obama’s signature health-care law?
“Every governor has a unique set of challenges; some have greater political challenges to overcome than others,” DGA chairman and Maryland Gov. Martin O’Malley told reporters Saturday at the National Governors Association annual meeting [...]
Governors of both parties are still studying the potential impact of the provision and have cited a long list of questions they have about how the expansion will be carried out, which many reiterated in interviews at the leaders’ annual summit in colonial Williamsburg. The topic was also front and center at a breakfast of Democratic governors Saturday morning and at a separate roundtable of Republican governors.
Specifically, O’Malley attributed this to the need to reach consensus in some states – and he’s clearly talking about the states where Democratic governors have resisted, like Missouri and West Virginia – where “legislatures… have invested so much politically into beating the president over the head with the Affordable Care Act and to falsely portray it as welfare expansion.” So he’s giving a political analysis. But there’s a policy analysis to be made as well, and O’Malley slipped into this:
And you know what, there are some people in that middle category of wanting to leverage as much flexibility from the federal government as possible that are Democrats and some who are Republicans.
I suspect that explains a lot of this. The Supreme Court put the states in a very advantageous position relative to Medicaid. They allowed them serious bargaining leverage to strike better deals with the federal government for their states, perhaps with more flexibility over implementation dates or how the coverage gets parceled out. You can see that in the list of questions from governors on both sides. So for some, there’s a bargaining phase.
For others there’s just an ideological rigidity. Rick Scott (R-FL) said on Fox News this weekend that “this is just another government program where the federal government will run out of money and they’ll put it on the states again.” The Health and Human Services Director of South Carolina said something very similar in much more bureaucratic language, arguing that health care is not just predicated on insurance, and that scarce state resources must be devoted to other priorities first. That’s a roundabout way of saying that the state just doesn’t want to pay the expense. And liberal wonks shoot themselves in the foot with their “good deal” analysis: there is an expense, not only with the federal match at 90% but with the “woodwork” effect, as people eligible under the old program enroll thanks to the newfound publicity, and then get covered under the old, lower federal matching guidelines.
Governors of both parties are basically stalling for time, as they see what the expansion means for their states, and how they can use this leverage to their advantage. Until that works itself out, it will be hard to lean on those ideologically opposed to providing coverage for their poorest citizens.