Political Animal


January 24, 2013 9:38 AM Rejecting Medicaid Expansion: No Ground To Stand On

By Ed Kilgore

One of the more bizarre phenomena transpiring across the country—sort of a slow-motion riot—involves the efforts of (mostly Republican) governors and state legislators to deny their citizens the benefits of the Affordable Care Act’s Medicaid expansion, which would significantly expand access to health insurance at a relatively small cost to states (a cost which is offset partially or even entirely by the reduction of uncompensated care).

At this point the leadership of ten states, all with Republican governors, have rejected participation in the Medicaid expansion. Five more states—again, all with Republican governors—are said to be “leaning against” participation. And things are entirely up in the air in twelve other states, eleven of them with Republican governors.

I guess you can perceive the pattern here, and it’s not a coincidence.

So of the most outspoken opponents of the Medicaid expansion have posed as representatives of their people resisting interference in their affairs by a distant, alien, socialistic Federal Government. Rick Perry of Texas, for example, has denounced “both the expansion of Medicaid as provided in the Patient Protection and Affordable Care Act and the creation of a so-called ‘state’ insurance exchange, because both represent brazen intrusions into the sovereignty of our state.”

But even in Texas, a new survey sponsored by the American Cancer Society Action Network has found, there’s strong majority support for the Medicaid expansion.

The survey extended to seven states that have been mulling the subject (in one, New Mexico, Gov. Susan Martinez has very recently come out for accepting the Medicaid expansion, making her one of just two Republican governors to do so), and the results were not ambiguous: majorities support the expansion before and after hearing the standard arguments for both positions. The percentage supporting their states’ taking the federal money and implementing the expansion range from 70% in New Jersey to 65% in New Mexico, to 63% in Florida, Kentucky and Michigan, and then 58% in Texas and 57% in Iowa.

The percentage of self-identified Republicans supporting the Medicaid expansion ranges from 32% in Texas up to 45% in Kentucky.

If Democrats cannot find a way to make this a campaign issue in 2014 in states where Republican incumbents have fought or defeated the Medicaid expansion, they aren’t really trying. Some variation on the theme of “Stupid Or Mean? Mean or Stupid?” might not be a bad slogan for describing the efforts of GOP state officials to carry on the national GOP’s war against Obamacare at their own states’ expense.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • martin on January 24, 2013 9:49 AM:

    Some variation on the theme of “Stupid Or Mean? Mean or Stupid?” might not be a bad slogan for describing the efforts of GOP state officials to carry on the national GOP’s war against Obamacare at their own states’ expense.

    Stupid AND Mean would be the more accurate formulation.

    Ok, Captcha is doing phone numbers now. Anyone want to call (203) 329-2111 and make someone's life miserable?

  • Barbara on January 24, 2013 9:50 AM:

    Susannah Martinez, Brian Sandoval and Jan Brewer have all said yea, so it's at least three, and I thought that a few other governors want to do it (Butch Otter of Idaho and the governor of SD) but it's not clear they have authority. By population and need for expanded access, though, you would have to classify Christie of NJ and Perry of TX as the stupidest and meanest of the lot. Basically, what they are doing, is imposing a huge private tax on hospitals that provide uncompensated care for uninsured residents of their states. That tax is passed on to everyone else, but especially insured residents.

  • c u n d gulag on January 24, 2013 10:04 AM:

    People in all states need to be coached to ask their Republican representatives, "Are you stupid, or are you mean?"

    And the best thing is, that question isn't just limited to ACA and Medicaid.

    You could ask the same about anything:
    The economy.
    Economic justice.
    Job safety.
    Actual justice.
    The environment.
    Voting rights.

  • Josef K on January 24, 2013 10:08 AM:

    I guess you can perceive the pattern here, and it’s not a coincidence.

    More of a factory-installed feature finally being recognized as such.

    One can but hope this results in a massive recall of the product inquestion.

  • Josef K on January 24, 2013 10:11 AM:

    And just to be clear, I'm not referring to either the Medicaid expansion nor the ACA!

  • Dee on January 24, 2013 10:32 AM:

    Hopefully this will push the country closer to having single payer healthcare. Being a U.S. citizen is all that should matter, not what zipcode you live in. Children have to get a Social Security number when they're born. It would be so much simpler, and cheaper, if that were your healthcare ID as well.

  • mmm on January 24, 2013 11:16 AM:

    Howard Dean said a few months ago that he didn't see how these governors could hold out, since hospital funds would dry up and face closing. Keep the spotlight on them, especially Rick Perry, since Texas has some very successful medical facilities, and the medical community has to be screaming.

  • junemax on January 24, 2013 11:59 AM:

    The SCOTUS decision in response to the GOP's lawsuit against Obamacare, altered a few things about ACA. Now, legal immigrants will get health care coverage, but state residents will NOT, UNLESS their state expands Medicare. Susannah Martinez and Jan Brewer have already figured this out, and saw the writing on the wall, so they've both signed on for expansion. Rick Perry, Rick Scott and the other Republican holdouts will sign on too- if they want to have a prayer of being reelected.

  • Barbara on January 24, 2013 12:02 PM:

    mmm, since the day of the Supreme Court decision, the Texas Hospital Association has said that their most important legislative priority is Medicaid expansion. Texas is probably the state where hospitals face the biggest direct threat of actually going under as a result of uncompensated care.

    The Texas Medical Association is also fairly powerful. In 2008, when John Cornyn was pushing to forestall MA HMO cuts by not acting to forestall physician cuts, the TMA went on the warpath and bought all kinds of tv advertisements basically accusing Cornyn of selling out doctors in order to boost insurers. Cornyn folded in a matter of days.

  • Lauren Marinaro on January 24, 2013 12:16 PM:

    Don't count out New Jersey, we're working very hard to get Christie to change his mind. Leaving aside the boost it would give to his budget, there are a combination of factors that could change the game here: 1) Sandy victims who need the assistance, 2) the flu season has really hit NJ hospitals bad, and 3) Sandy Hook--the Gov. has been re-emphasizing mental health in the wake of this, and Medicaid coverage would certainly help people get the mental health services they otherwise lack. There has been a lot of press in these three areas that tie to Medicaid.

    I think his biggest legitimate concern would be a border effect that the Roberts ACA decision causes. If he takes the expansion and Corbett in PA doesn't, there will be an influx to NJ from across state lines--that is why the expansion was mandated in the first place; to protect the states that would have expanded regardless form other "freeloading" states. What is extortion to one governor is needed protections for the other ones.

  • smartalek on January 24, 2013 4:23 PM:

    If you want to do the Nader-voter thing -- in this case, to keep Publicans misbehaving so you can feel more politically pure and/or to worsen the horror in the hopes of sparking the Revolution -- by all means, go with "Stupid or mean?"
    But as I've noted before, to these creeps, "mean" is a compliment; indeed, a badge of honor.
    (Remember the stories and vid's of Teabeggars throwing crumpled dollar-bills at people in wheelchairs? Pushing their fellow-citizens to the ground and kicking or stomping on them?)
    If you actually want to sway voters, "Stupid or crazy" would not only be more likely to push the right buttons, it would be more objectively accurate as well, because of the self-destructive impacts on uncompensated care, and the costs to taxpayers and the insured.

  • Doug on January 24, 2013 6:01 PM:

    smartalek, I don't think the slogans would be trying to change the votes of Tbaggers/RWNJs, rather they would be aimed at those who vote (R) and aren't insane.
    There have to be some...

  • AJAY JAIN on March 29, 2013 7:40 PM:

    Hello Friends,

    Governor Rick Perry millions of under-privileged poor Texans who do not have any Health Coverage will be covered under The Affordable Care ACT (ACA) expansion of MEDICAID!

    My Physician wife's practice is partly dependent on MEDICAID and its viability. Please allow the expansion of MEDICAID to occur in Texas under The Affordable Care ACT.

    FACT: If states choose to expand Medicaid, the federal government will cover 100 percent of the costs from 2014 to 2016. The feds' contribution will begin to decrease in 2017, but will never be less than 90 percent, under the ACA.

    That's why I created a petition to Governor Rick Perry, Texas Governor, The Texas State House, The Texas State Senate, and Governor Rick Perry, which says:

    "Please ACCEPT the FREE EXPANSION of MEDICAID under The Affordable Care ACT."

    Will you sign this petition? Click here:


    Ajay Jain
    Twitter Handle ajain31
    Mobile: 214-207-9781