Another boost for the Medicaid expansion

Here’s another episode that reveals that the politics of Obamacare are more complex for Republicans than their tidy political narrative allows.

In some good news out of New Hampshire, the GOP-controlled state senate has just passed the state’s version of the Medicaid expansion, after a contentious fight. It’s now headed to the Dem-controlled house, and it’s expected to pass and get signed by the Dem governor. It could expand health coverage to over 50,000 people and boost the state’s economy.

This could put Republicans who support the expansion in the state at odds with Republican candidates vying to challenge vulnerable Dem Rep. Carol Shea-Porter.

If it does become law, it will be a loss for the Tea Party group Americans for Prosperity, which lobbied against the expansion and is running campaigns against expansions in multiple other states. AFP is making a big stand against Obamacare in New Hampshire, pounding Shea-Porter and another Dem with ads featuring alleged Obamacare victims who turned out to be Republican activists.

Shea-Porter, a top AFP target, hopes to use the expansion to muddy up the Obamacare issue. Former Rep. Frank Guinta and businessman Dan Innis are competing for the GOP nomination, and Porter hopes to use the expansion — which is vociferously opposed by conservatives there — to challenge her eventual opponent on whether he would take benefits away from tens of thousands. In a statement, she said:

Frank Guinta and Dan Innis need to choose — do they still stand with the Tea Party and the Koch Brothers and oppose the Medicaid expansion, or will they stand with the bipartisan majority of Granite Staters who support it because it’s good for our state’s economy and citizens’ health?

The big story is that the Medicaid expansion is creating complications for Republicans. In Michigan, the GOP Senate candidate came out for the expansion set to kick in this spring, even though the ad barrage from AFP there is supposedly making Obamacare toxic. In Arkansas, the drive to repeal the expansion failed, with one Republican coming out for keeping it because he didn’t want to see “innocent people hurt.” The issue could impact the Louisiana Senate race, where the expansion will be debated this spring and Dem Mary Landrieu will make it an issue against her challenger.

The Medicaid expansion is forcing Republicans to reckon with the true implications of their health care stance. As Jonathan Bernstein explains, interest groups within these states don’t want to turn away all that federal money. With enrollment mounting daily, it’s becoming harder for Republicans to pretend the law’s beneficiaries don’t exist, and the repeal stance will continue to crack up.

Obamacare could remain a serious liability for Dems. But as repeal gets less tenable, it could create pressure on GOP candidates to articulate alternatives. Since there’s no real policy space for a meaningful alternative, this could force them to embrace the law’s general goals and slowly turn Obamacare into a political wash.

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