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Can Dems win on the Medicaid expansion?

.. "turtle face" .. thanks, to Stephanie... lol .. sure is ..

By Greg Sargent
November 25 at 2:45 pm
550 Comments


Mitch McConnell (AP Photo/J. Scott Applewhite)

The big Washington Post piece .. http://www.washingtonpost.com/national/in-rural-kentucky-health-care-debate-takes-back-seat-as-people-sign-up-for-insurance/2013/11/23/449dc6e0-5465-11e3-9e2c-e1d01116fd98_print.html .. reporting on poor Kentucky residents now gaining access to health care under the Affordable Care Act continues to resonate today. Markos Moulitsas highlights .. http://www.dailykos.com/story/2013/11/25/1258248/-Obamacare-and-brand-new-Democrats-The-GOP-s-biggest-nightmare .. the case of Ronald Hudson, a 35-year-old man with high medical bills who had this to say, after learning he would now be covered under the Medicaid expansion:

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“Well, thank God,” Hudson said, laughing. “I believe I’m going to be a Democrat.”
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Which raises a question: Despite Obamacare’s unpopularity, can Dems nonetheless campaign aggressively on the Medicaid expansion, on the theory that the more people get covered, the harder it will be to take coverage away from them?

As Moulitsas put it .. http://www.dailykos.com/story/2013/11/25/1258248/-Obamacare-and-brand-new-Democrats-The-GOP-s-biggest-nightmare : “A rural southern white male is openly talking about becoming a Democrat. Why? Because Democrats have now made his life a little better…Hudson will have a stark choice in 2014: Vote for Mitch McConnell, who wants to take away his health security just as he finally gets it, or for Alison Lundergan Grimes, who won’t.”

This is not a slam dunk issue for Republicans. At a press conference in Kentucky earlier this month, Mitch McConnell was pressed on the Medicaid expansion — which is responsible .. http://www.courier-journal.com/article/20131112/NEWS01/311120047/Sen-Mitch-McConnell-Democratic-Party-collapse-only-hope-healthcare-relief?nclick_check=1 .. for 85 percent of new signups in Kentucky — and on the benefits the law will extend to people. He didn’t have a very good answer. The Courier-Journal reported it this way .. http://www.courier-journal.com/article/20131112/NEWS01/311120047/Sen-Mitch-McConnell-Democratic-Party-collapse-only-hope-healthcare-relief?nclick_check=1 :

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McConnell took umbrage at the argument that the numbers in Kentucky add up to a successful program.

“Well look, if I went out here on the street today [and said], ‘You guys want free health care?’ I expect you’d have a lot of signups,” he said. “People signing up for something that is free” is the only thing about Obamacare in Kentucky that could be considered successful.

Asked more than once what parts of Obamacare, if any, were beneficial to the millions of people in the country without health care, McConnell had only one answer, stating repeatedly: “The law should be repealed.”
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McConnell’s answer: Resort to a variation of Mitt Romney’s ”free stuff .. http://www.washingtonpost.com/blogs/guest-voices/post/free-stuff-the-message-from-romneys-naacp-speech/2012/07/12/gJQAFNhGgW_blog.html ” argument, and to avoid direct questions about the benefits of the law for millions.

If the law works over time, this could only get harder for Republicans. And this is the other side of the big argument over those losing their coverage and seeing premiums rise. Republicans are absolutely certain this development is already a huge winner for them. But as Brian Beutler notes .. http://www.salon.com/2013/11/25/right_wing_extremists_face_new_moral_conundrum/ , a new Families USA study .. http://www.familiesusa.org/ACA-individual-market/ .. finds that over 70 percent of those on the individual market who are under 65 will become eligible for financial help getting other coverage, whether through subsidies or through the Medicaid expansion.

If the website gets fixed, Democrats will be helping those people get coverage, and in many cases they may find they like it better. Meanwhile, Republicans will be faced with a choice between continued Total War against the law, including the Medicaid expansion, and the “moral imperative they face to direct these constituents toward new options.” Worse, Republicans will continue to face pressure from the right not to accommodate the Medicaid expansion, an issue that is already dividing GOP governors .. http://www.nytimes.com/2013/11/22/us/politics/health-law-is-dividing-republican-governors.html?_r=0 .. and even emerging as an issue in GOP primaries .. http://www.washingtonpost.com/blogs/plum-line/wp/2013/11/20/the-next-conservative-litmus-test-opposition-to-medicaid-expansion/ .

Will Dems campaign aggressively on the Medicaid expansion? For them, the politics of the issue may well turn on how it’s framed. Polls show .. http://www.washingtonpost.com/blogs/plum-line/wp/2013/11/20/the-morning-plum-on-obamacare-a-stark-racial-divide/ .. that majorities of Americans think the health law will help poor people and those without insurance, but not that it will help them or the country overall. Dems may well worry that if the Medicaid expansion gets framed solely as expanding a government program for the poor — the handout that McConnell describes — it could put them at risk. Dems will probably emphasize that the expansion is sound budgetary policy, arguing that it makes sense for states to accept huge amounts of federal money. (Terry McAuliffe won in the purple state of Virginia while emphasizing both of those framings.)

At first red state Dems may shy away from the Medicaid expansion a bit. But ultimately, if Obamacare works over time, Republicans may be the ones who are really left struggling to explain their stance on it.

http://www.washingtonpost.com/blogs/plum-line/wp/2013/11/25/can-dems-win-on-the-medicaid-expansion/

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Medicaid dollars put GOP in quandary

Debra J. Saunders
Updated 7:06 pm, Friday, November 22, 2013


The latest issue roiling the Republican Party is Medicaid, specifically whether Republican governors should expand Medicaid with federal Affordable Care Act money - especially if they want to be on the GOP national ticket in 2016.

It's a hot issue because Obamacare allows states to expand their pool of eligible Medicaid recipients. For the first three years, Washington promises to pay 100 percent of the freight for new enrollees; later, federal support would shrink to 90 percent. (Washington covers about half the cost of today's pre-ACA enrollees.)

It's as free as free money gets in this country - nearly $1 trillion over 10 years, which leaves Republican governors with a dilemma. To snatch or to spurn, that is the question.

More than 20 states with Republican governors or legislatures have refused the new Medicaid scheme. Texas Gov. Rick Perry and Louisiana Gov. Bobby Jindal lead the pack of GOP guvs who said no. Jindal said the so-called free Medicaid money "would cost Louisiana taxpayers up to $1.7 billion over the next 10 years and move nearly 250,000 Louisianans from private coverage to Medicaid."

Last week, the Club for Growth called out an Idaho congressman for accepting the endorsement of an industry group that supports Medicaid expansion in Idaho. Club spokesman Barney Keller told me the issue isn't exactly a litmus test, but "anyone who thinks that the feds are going to make good on their promises to pay for the Medicaid expansion are kidding themselves."

This month, Sen. Rand Paul, R-Ky., told Fox News that New Jersey Gov. Chris Christie could be sorry the Garden State is expanding Medicaid under Obamacare. "I don't think that is going to resonate in the Republican primary," quoth Paul, who himself seems eager to run in 2016.

Christie is in good company. Other GOP governors - John Kasich of Ohio, Jan Brewer of Arizona and Rick Scott of Florida - are taking advantage of the Obamacare Medicaid terms.

Sparring with Laura Ingraham on Fox News, Kasich gave an impassioned defense of his decision. It's his job to "bring Ohio money back to Ohio," Kasich said. His constituents pay federal taxes; if he says no to Obamacare dollars, "they're not going to put (the money) in a piggy bank."

And: "It's not like it's cost-free to turn this down."

Kasich played up his brand of compassionate conservatism: "Conservatism means that you help people so they can help themselves, and they can enter into the economic strength of their country." After Kasich went around Ohio's GOP Legislature to add 275,000 to his state's Medicaid rolls, his anemic poll numbers increased.

Wisconsin Gov. Scott Walker split the baby. He proposes moving 77,500 people off Medicaid and into private subsidized plans. He also would enroll new people into Medicaid with ACA dollars. "Some governors chose not to take the expansion. Some chose to take it," Walker told Politico. "I wanted to find a way to reduce the number of people who were uninsured and still do something in a way that did not put my taxpayers on the hook."

Given problems Cheeseheads are having signing on to the federal exchanges, Walker has put his "smarter, simpler and better" plan on hold.

I don't see the Obamacare Medicaid money as free. In three years, states will have to pay up. Washington could cut federal payouts. Also, since states underpay providers, more Medicaid recipients could mean longer waits to see a doctor. Still, a governor is elected not to run for the White House but to do what's best for his state. How can groups like the Club for Growth expect elected officials to say no to what their constituents see as free money?

"That's why the left loves Medicaid," responded health care wonk Michael F. Cannon of the libertarian Cato Institute. "It's socialism on stilts. You've got a program where each side" - state and federal - "contributes half the money, each side has enormous incentive to expand it." If there's fraud or waste, the federal government pays for half of that bad spending - and all of it for new Obamacare enrollees - and state politicians reap all the benefits.

Cannon doesn't trust Washington not to cut subsidies tomorrow that it promises today. GOP governors, he warned, beware.

"When this law passed, no one thought there would be this much resistance to the Medicaid expansion," Cannon continued. While he finds it predictable that some GOP governors signed on, "what is amazing is that so many states have said no. That's the story."

Should governors trust Washington?

Some critics charge that Washington won't honor the Affordable Care Act's promises to fund new Medicaid enrollees - which suggests that states should be wary before they sign on.

-- In 2012, the Obama administration floated the idea of a "blended rate," which, Politico reported "really means one thing: Less federal money to cover the neediest."

[ Politico .. What Medicaid cuts might look like
http://www.politico.com/story/2012/12/medicaid-cuts-84821.html ]

-- In 2012, GOP House Budget Committee Chairman Paul Ryan supported block grants, also billed as an efficiency move. According to the Center on Budget and Policy Priorities, the Ryan plan would have resulted in a 34 percent cut to Medicaid spending over a decade.

Debra J. Saunders is a San Francisco Chronicle columnist. E-mail: [e-mail] Twitter: @DebraJSaunders

http://www.sfgate.com/opinion/saunders/article/Medicaid-dollars-put-GOP-in-quandary-5002881.php

See also:

OBAMA SAYS AMERICANS CAN KEEP THEIR DAMN INSURANCE
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