Political Animal


February 21, 2013 4:27 PM Turning Point on Health Care? Not So Fast

By Ed Kilgore

Because of the close proximity of Rick Scott’s surprising decision to accept the Affordable Care Act’s Medicaid Expansion, and the appearance of the Holtz-Eakin/Roy strategy document for how Republicans can live with Obamacare (which I wrote about yesterday), there’s a temptation for progressives to declare big corners turned, as Jonathan Chait did today:

From the moment President Obama set out to reform the health-care system, Republican opposition was a Terminator robot driven by a boundless, remorseless determination to kill. Every single Republican in Congress opposed the bill, and Republicans who even considered supporting something vaguely like it were ruthlessly purged. Even after it was passed, Republicans ginned up far-fetched legal challenges, held endless votes to repeal it, and vowed not to implement it at the state level. They couldn’t be bargained with, couldn’t be reasoned with, and felt no pity.
The repeal machine has suffered a series of devastating blows — the Supreme Court upholding the individual mandate, Obama’s reelection, the decision of several Republican governors to accept the program’s expansion of Medicaid — and continued to lurch forward. But Governor Rick Scott’s announcement that he will enroll uninsured Floridians in Medicaid appears to be a real death blow, the moment the cyborg’s head is crushed in a steel press.

I dunno about that last part. Odds of an actual repeal of Obamacare evaporated on November 6, since there’s no realistic scenario where the president could be convinced to sign a repeal of his most important legacy legislation, or where Republicans could muster the votes to override a veto. As for the Medicaid expansion: It’s certainly a big turning point for the uninsured in Florida, assuming Republican legislators ratify Scott’s decision. But I see no particular reason to believe that Scott’s “betrayal of his conservative principles” is going to have any impact on Rick Perry, Nikki Haley, Nathan Deal, Phil Bryant, Robert Bentley, Mary Fallon, Paul Le Page, Mike Pence, or other Republican governors deciding or threatening to reject the expansion. They are mostly in better political shape than Scott, and all would regard stopping the Medicaid expansion as a career highlight and probably as a ticket to post-gubernatorial fame and fortune in the various precincts of wingnutland.

And while I agree the Holtz-Eakin/Roy document is a big deal, it by no means represents a strategy that today’s Medicaid refuseniks can’t seamlessly adopt. The whole approach is to use the health exchanges created under Obamacare as a wedge to gradually vitiate Medicare and Medicaid. Rejecting the Medicaid expansion is pretty obviously a big step in the same direction, since it would expand the operation of the exchanges in most states. The implementation of Obamacare, with various degrees of buy-in from the states and from Republicans, represents less a turning point in the battle than a change of landscape.

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.


  • Theda Skocpol on February 21, 2013 4:52 PM:

    Le Page is in good political shape? Poppycock. Too much doomsaying, Ed.

  • N.Wells on February 21, 2013 5:14 PM:

    I think the Republicans and anti-Obama businesses are setting themselves up for a massive dose of unintended consequences.

    It seems to me that the more Republicans and businesses impede Obamacare, the faster we get to single payer or something similar. I don't think the Supreme Court is going to find a new reason to nullify Obamacare, and it isn't going to get repealed, particularly since Kasich and Scott have signed on to it. What Republicans and businesses can do is make it vastly more expensive by making more workers part-time and dumping them into federal subsidies, and making people in Republican states go through the federal exchange, thereby increasing the burden on the federal budget. But as the cost accelerates, the pressure for a fix will increase, and it will become obvious that the options are taking away healthcare (which isn't going to fly once people start getting it), or finding ways to cut costs. Once that happens, the obvious and immediate cost savings will be negotiating drug purchases in bulk, perhaps from overseas; cutting out the completely useless private insurance companies in favor of a single-payer system, and running everything through a single federal bureaucracy. And there go all the things that Republicans were initially trying to protect by suggesting mandates and protecting pharmaceutical companies and insurance companies and the like.

  • esaud on February 21, 2013 5:15 PM:

    Scott accepted Medicaid expansion only because he will be making tons of money off of it.

    There is no epipheny here, just $$$$$$$.

  • paul on February 22, 2013 8:58 AM:

    Assuming for the moment that it gets past Florida's crazier-than-Rick state legislature, Scott's deal actually has more potential to damage Obamacare than the refusals. Not only is it for privatization of Medicaid, which essentially means that Scott's friends get to rake in billions of dollars of federal money while providing no services, it only lasts for three years, at which point all those people will be dumped without coverage unless the federal government agrees to blackmail terms to be named later.

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