December 20, 2013

Talking Points Memo’s Dylan Scott talks to health industry players who have grown increasingly pessimistic about persuading red states to opt in to the Medicaid expansion:

Support for Medicaid expansion from within the health care industry — in particular from providers like hospitals, doctors and nursing homes — is a key part of the coalition that Obamacare advocates have hoped will help eventually turn the tide in the non-expanding Republican-dominated states.

But top officials for powerful trade organizations in three of the largest states not expanding Medicaid under Obamacare told TPM that they have effectively given up that fight until political conditions change, setting their sights on 2015 at the earliest. [...]

“It just isn’t going to happen,” the official continued. “The more you talk about Medicaid expansion, the more you’re talking about Obamacare, the more you’re talking about Obama, the more you’re talking about a problem. Frankly, the more we talk about it, I think the more entrenched they get that it’s not something that they’re going to do.” [...]

It’s a stark reminder for Obamacare advocates that, while the White House is pushing hard for expansion and supporters are mobilizing those left out of the Medicaid expansion to lobby their state lawmakers, they’re still fighting an uphill battle. Convincing Republican politicians to endorse President Obama’s signature legislative achievement in an election year is going to be a tough sell.

Groups pushing for the expansion thought they had a winner on their hands, but it isn’t turning out that way:

These organizations approached Medicaid expansion as a typical legislative issue last year — the kind where the promise of billions in federal dollars and opportunity to insure thousands of your constituents would trump ideological purity. But as national political leaders and political committees with money to spend applied the pressure, many state officials ultimately held to the national party line.

Well, that’s too bad. As Kevin Drum puts it:

A lot of people, myself included, have hoped that pressure from health care groups will eventually persuade even deep red states to enact the Medicaid expansion that’s part of Obamacare. After all, the expansion is almost entirely paid for by the federal government, and the loss of Medicaid money hurts doctors and hospitals in the affected states. [...]

Ideological purity continues to trump the prospect of helping the poor, even when that help is all but free. Ladies and gentlemen, this is your modern Republican Party.

Okay, but where are Republican voters on this? It turns out that they aren’t really hostile to the idea of helping the poor pay for health care in the numbers you might think. Yesterday’s New York Times/CBS poll asked respondents:

Do you approve or disapprove of the part in the 2010 health care law that provides financial help to low and moderate income Americans who don’t get health insurance through their jobs to help them purchase coverage?

Among all Americans, 76 percent approve, while only 21 percent disapprove. I asked the CBS polling team for the numbers among Republicans. It turns out 56 percent of Republicans approve, while only 40 percent disapprove.

Now, that description is not quite the same as the Medicaid expansion. But some GOP-controlled states, such as Arkansas, are experimenting with their own versions of the Medicaid expansion that are designed to approximate using federal money to subsidize private coverage for those who can’t afford it. And a majority of Republicans supports that idea. So there is a way to get this done that Republicans could accept.

There’s an interesting nuance here, by the way. The poll also asks whether “providing health coverage for the poor is the responsibility of the federal government.” Asked this way, Republicans answer No by 70-25. Call this “government,” and Republicans oppose it. But call it helping low and moderate income Americans to purchase coverage, and they support it.

And of course, if you call it “Obamacare,” there’s no way Republicans will embrace it, ever. Which has always been the crux of the problem.

Greg Sargent writes The Plum Line blog, a reported opinion blog with a liberal slant -- what you might call “opinionated reporting” from the left.