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The two largest states that have so far failed to join in the Medicaid expansion provided for in the Affordable Care Act are Florida and Texas, where Republicans control the legislature and the governor’s office. Looking more closely at the intra-Republican battle over how and whether rich new federal funds can be captured without “surrendering” to the hated Obama provides a fascinating glimpse into conservative ideology and tactics.
Florida offers the murkiest situation. Gov. Rick Scott, who was beginning to look rather toasty in his 2014 re-election prospects, roiled conservative circles in his own state and nationally by suddenly coming out for Medicaid expansion in exchange for permission from the Obama administration to move Medicaid beneficiaries into private managed care plans. But Scott’s been stopped cold by GOP legislators, who in turn seem split between outright rejectionists centered in the state House and those in the Senate who want an even better “deal” that would utilize the state’s CHiP program, which is a privatized premium support scheme, instead of Medicaid for the expansion.
A conservative Florida reporter presents the views of the rejectionist camp quite vividly:
Tom Lauder, a reporter for Media Trackers Florida, which is closely following the Florida Obamacaid debate, says House Republicans appear likely to stand firm….
“Grassroots conservatives are particularly upset with Gov. Scott using the language of the left in his efforts to build momentum for Obamacaid,” Lauder explained. “When Scott argues, ‘I cannot, in good conscience, deny the uninsured access to care,’ he asserts that the only time people have access to goods and services is when government gives it to them as an entitlement. Scott has enraged his conservative base by making this big-government argument. This isn’t a question of whether government should give Medicaid to the poor and disabled, because the poor and disabled already qualify for Medicaid.”
At issue, Lauder says, is the rejection of Scott’s argument that federal funding will come without cost to state taxpayers.
“Scott’s conservative base also resents Scott talking about federal funding as if it were free money,” Lauder added. “Even if the federal government kept its promise to fund most of the Florida Medicaid expansion, which many conservatives doubt will be the case, Floridians pay federal taxes in addition to state taxes. Federal dollars flowing into Florida are not free dollars, even for Floridians.
In other words: Florida’s “true conservatives” don’t much care what mechanism is being used to expand coverage; they’re just flatly against it.
It Texas, meanwhile, the rejectionist camp is led by Gov. Rick Perry, as Ron Brownstein explains in a National Journal column:
Republican state Rep. John Zerwas, a health care leader who represents a district outside Houston, says legislators are getting an earful at home from providers and local officials worried about the state rejecting the money.
Against that backdrop, Zerwas and some GOP state House colleagues are searching for ways to steer Texas into the expansion. They assume the state will not move more people into the existing Medicaid program. But they consider it misguided to simply reject the federal money and deny insurance coverage to so many people who could obtain it. “We are not going to make this better … without doing something that substantially reforms how we deliver Medicaid,” Zerwas says. However, “we have to have a solution for this group of people.”
Last week, Zerwas introduced legislation that would authorize state health officials to negotiate with the Obama administration to expand while delivering coverage for the newly eligible through new means. He likes the deal the administration is discussing with Arkansas, which could allow the state to use Medicaid expansion dollars to instead buy private insurance for its eligible adults, and he believes that approach could be “sellable to the governor.”
Many here, though, wonder if Perry would take any deal. The widespread belief is that he intends to seek the GOP presidential nomination again in 2016, and accepting more Medicaid money would smudge his image of Alamo-like resistance to Obama.
This is an interesting scenario given recent efforts from the Perry camp (outlined earlier this week in another National Journal piece by Michael Catalini) to depict the swaggering, gaffe-prone Texan as “ahead of his time” in understanding the need for Republican outreach to Latinos. Notes Brownstein:
[I]f state Republicans reject federal money that could insure 1 million or more Hispanics, they could provide Democrats with an unprecedented opportunity to energize those voters—the key to the party’s long-term revival. With rejection, says Democratic state Rep. Rafael Anchia of Dallas, Republicans “would dig themselves into an even deeper hole with the Hispanic community.”
It’s unclear how this will all play out in Florida and Texas. But nobody recently has lost any money betting on the hard-core conservative approach, particularly on an issue as incendiary to the Right as Obamacare. That rejecting any sort of coverage expansion beyond that absolutely required by the ACA would mean leaving vast sums of federal money on the table would in fact be considered a badge of honor by a lot of the people involved.
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c u n d gulag on March 22, 2013 11:18 AM:
Ed,
Conservative "ideology" and "tactics" boil down to the same thing - obstruct progress by ANY and EVERY means possible.
They stand for nothing.
They are against everything - except themselves.
And even then, there's infighting.
They are sociopaths who spit out any medicine offered to them, while they scheme to take-over the asylum.
Rick B on March 22, 2013 11:35 AM:
What gets me is that the core of the conservative approach is to ALWAYS oppose anything Obama proposes. Anything at all.
It's as though anything the Black Kenyan Muslim is improperly occupying the office which belongs properly to Republicans. They act as though Obama is pure evil and must be fought on all fronts like the armies of Hell.
emjayay on March 22, 2013 11:45 AM:
"He likes the deal the administration is discussing with Arkansas, which could allow the state to use Medicaid expansion dollars to instead buy private insurance for its eligible adults..."
What kind of useless private insurance could possibly cheaper than the low overhead, low provider reimbursement Medicaid? How would the high overhead private insurance also pay for millions of dollars of its CEO pay? Reduce reimbursement to $5 an appointment restricted to a pool of 5 doctors who don't speak English? One doctor appointment a year and no followups? Anyone know anything about this proposal?
As usual, the Obama administration seems to be way too flexible and compromising while dealing with inflexible no compromise authoritarian Republican idealogues.
KK on March 22, 2013 11:47 AM:
Wasn't it ever thus? I believe Groucho said it best in horse feathers ...
I don't know what they have to say,
It makes no difference anyway,
Whatever it is, I'm against it!
No matter what it is or who commenced it,
I'm against it!
Your proposition may be good,
But let's have one thing understood,
Whatever it is, I'm against it,
I'm against it.
In opposed to it,
On principle, I'm opposed to it
He's opposed to it
In fact, in deed he's opposed to it
For months before my son was born,
I used to yell from night to morn,
Whatever it is, I'm against it
And I've kept yelling since I first commenced it,
I'm against it!
boatboy_srq on March 22, 2013 12:06 PM:
Grassroots conservatives are particularly upset with Gov. Scott using the language of the left
In other words, it doesn't even matter about the spending - it's simply the act of making it sound Lefty (translation: Gawdless, Librul, Soshulist and unAhmurrcan) that's the problem.
I'm waiting for them to have fresh problems with form[ing] a more perfect Union, ensur[ing] domestic Tranquillity, Provid[ing] for the common Defence and promot[ing] the general Welfare.
Anonymous on March 22, 2013 12:20 PM:
Oh, I found the link in the next post down which is to a post and usefull discussion on the Obama administration caving once again in favor of much worse and expensive Republican crap.
http://www.washingtonmonthly.com/political-animal-a/2013_03/gops_health_reform_plan_b_in_a043495.php
(Someone tell me how to do a link in the more slick way as actually seen in the post below?)
I still don't get it. Not caving = states with no expanded coverage = certain states being known for being even more of an embarassing hellhole than they already are = Democrats winning elections = inequity addressed. Isn't that how politics is supposed to work?
Captcha: assifect schools
Whoulda been perfect for a comment about education!
Epicurus on March 22, 2013 12:32 PM:
Perry to run again! I'm making popcorn...
Josef K on March 22, 2013 12:55 PM:
Florida offers the murkiest situation.
Personally I always thought it was just a deliberate move by Scott to ensure (a) his image as a moderate would get some shine while (b) ensuring FL saw no expansion in coverage. He took the deal knowing ahead of time the Statehouse would reject it. He's a crook remember, and he knows how to game the existing system.
It Texas, meanwhile, the rejectionist camp is led by Gov. Rick Perry
Perry is a little easier to understand, I think. He's got a compliant, at-best-half-time state legislature and the backing of well-heeled nativists, so he probably thinks he can safely ignore the uninsured and whatever negaitve press this generates. He doesn't strike a much of a long-term thinker, preferring the fictional imagery of Texas literally being the Alamo (himself as James Bowie, maybe) in the last days of the seige in 1836. I further wonder if he isn't expecting actual martyrdom as a result; the rebels died in that mission, remember.