The failure of the American Health Care Act may have an unintended consequence that will make it harder to dislodge Obamacare’s entitlements in the future. After Speaker Paul Ryan’s admission that “We’re going to be living with Obamacare for the foreseeable future,” several red states are considering Medicaid expansions under the Affordable Care Act.
The Wall Street Journal reports that 19 states, most of which are reliably Republican, rejected the ACA’s Medicaid expansion to cover low-income families after the Supreme Court struck down the mandatory expansion of Medicaid and made it optional for the states. Federal funding for the expanded program was covered at 100 percent for three years and would reduce to 90 percent in 2020. The federal government typically pays about 60 percent of Medicaid spending.
“The thing that held states back was that they were going to end Medicaid expansion,” Adam Searing, a research professor at Georgetown University’s Center for Children and Families, told the Journal. “Now when you have the House speaker saying this is going to stay, it’s like, ‘We may get the money, why not explore it?”
The Kansas Senate voted to approve the Medicaid expansion on Tuesday, two working days after the Republican health bill failed. CNN reports that the Kansas House had passed the bill earlier this year. The bill now goes to Gov. Sam Brownback (R) who is not expected to sign it into law.
“To expand Obamacare, when the program is in a death spiral, is not responsible policy,” Gov. Brownback said.
The Journal reports that several other states are expected to reconsider the Medicaid expansion since the ACA now appears to have survived the Republican challenge. These include Idaho, Florida, Georgia, Missouri, Utah and Wyoming.
North Carolina’s Democrat governor, Roy Cooper, initiated the Medicaid expansion process after taking office in January. The Winston-Salem Journal said that the expansion was a top priority for Gov. Cooper, but he has met resistance from Republicans in the General Assembly.
Ironically, a Republican administration may make it more likely that red states buy into the Medicaid expansion. Secretary of Health and Human Services Tom Price has the power to issue regulations that affect how Medicaid money is spent. A more conservative approach that includes work requirements and more leeway on how states spend Medicaid money may entice Republican state governments to opt in.
If more states enact the expanded Medicaid entitlement, it will be even harder to kill Obamacare in the future. The AHCA was derailed by Freedom Caucus members who, among other things, objected to the way the bill handled the expansion. The AHCA’s slow phase out of the Medicaid expansion was made necessary by four Republican Senators (Lisa Murkowski of Alaska, Corey Gardner of Colorado, Rob Portman of Ohio and Shelly Moore Capito of West Virginia) whose states elected to buy into Obamacare’s Medicaid expansion. If more states expand Medicaid, it is likely that more Republican congressmen will decide to protect the federal Medicaid money flowing to their states.
Some popular Republican governors are already resisting the repeal of the Medicaid expansion as well. John Kasich (R-Ohio), who finished third in the 2016 Republican primary, called the Republican plan to repeal the expansion “a very, very bad idea” according to CNN.
The Trump Administration denies that the effort to repeal Obamacare is over, but there seem to be no plans to move forward. “Have we had some discussions and listened to ideas? Yes,” Press Secretary Sean Spicer told the Journal. “Are we actively planning an immediate strategy? Not at this time.”
As more states and taxpayers receive federal Obamacare money, the law will be harder and harder to repeal. Government money has the power to make addicts of both individuals and states.
Originally published on The Resurgent