Indiana governor Mike Pence has released a plan to allow his state to accept the expansion of Medicaid under the Affordable Care Act. This is a story about health care, but at the same time it signals a dramatic shift in the GOP, one with potentially profound implications for the 2016 presidential race.
Pence isn’t the first GOP governor to accept the Medicaid expansion, and like some others he is trying to do it in a way that incorporates Republican ideas — moving Medicaid recipients to private insurance, making them pay some premiums, forcing them to use medical savings accounts. But unlike some of those other governors who have found the billions in federal dollars to insure their low-income population too good to pass up, Mike Pence is considering a run for president. And he’d be a serious contender — long admired by conservatives when he was in Congress, and now with the prestige being a governor brings.
Governors have more practical considerations than senators do. The uninsured in Pence’s state present an economic and moral problem that cries out to be dealt with, and solving it would make his state healthier in multiple ways.
But that doesn’t change the political calculus for a potential presidential candidate. And the fact that Pence is rolling out this proposal even as he is considering a presidential run speaks volumes about where the debate within the Republican party could be moving.
Six months ago, the idea that a serious contender for the GOP nomination would allow himself to be tainted in even the remotest way with the stench of Obamacare would have been dismissed as ridiculous. But Pence’s move suggests that by the time we reach the heat of the pre-primary season a year or so from now, it will be possible for a Republican candidate to have made at least some accommodation to the law. A candidate like Pence might be able to say: “Yes, I hated it as much as all of you, but it isn’t going away no matter how many repeal votes Republicans in Congress take, so I tried to channel it through conservative principles.”
That argument won’t make primary voters stand up and cheer. But there’s a line of acceptability for those voters on this issue, and the facts on the ground, with none of the right’s prophecies of doom coming true, may be moving that line as we speak. It may no longer be all or nothing — primary voters may ask not whether every candidate fought the law with every fiber of his being, but rather, they may pose somewhat more moderate and reasonable question. Did he make his opposition clear? Does he have good conservative ideas about health care?
If Pence can answer yes to those questions even if he ended up taking the federal Medicaid money, then it might become clear that Obamacare repeal is not be shaping up as quite the 2016 GOP litmus test everyone expected.
And that in turn make it politically possible for more Republican states to accept the Medicaid expansion and provide insurance for their poor citizens. Which would be a very good outcome indeed.