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December 23, 2013 2:29 PM Red States and the Future of the Medicaid Expansion

By Ryan Cooper

Here at Political Animal Ed has been rather skeptical of the fate of the Medicaid expansion in Republican states. Some argue that the coalition of powerful and wealthy interest groups—doctors, insurance companies, etc—that would benefit hugely from the expansion would eventually bring Republicans around, while other were skeptical of those groups’ purchase on Republican officeholders.

Recently Dylan Scott had a great piece that validated the skeptics’ concerns. Healthcare lobbyists, he reported, are about ready to give up on the Medicaid expansion, at least in the short term:

But top officials for powerful trade organizations in three of the largest states not expanding Medicaid under Obamacare told TPM that they have effectively given up that fight until political conditions change, setting their sights on 2015 at the earliest.
“What I’m really struggling with is — I don’t even know how to talk about expanding Medicaid without just pissing Republicans the hell off and making them think I’m part of the problem,” said a top official for one of the industry groups, who spoke on the condition of anonymity to talk frankly about the political reality in their state and avoid upsetting the chances of expansion in the long term.
“It just isn’t going to happen,” the official continued. “The more you talk about Medicaid expansion, the more you’re talking about Obamacare, the more you’re talking about Obama, the more you’re talking about a problem. Frankly, the more we talk about it, I think the more entrenched they get that it’s not something that they’re going to do.”

So we see the limits of the influence of the monied elite over the Republican base. When it conflicts with enraged opposition to 100% of the Obama Agenda, as perceived by the Republican base, then opposition wins. The question, though, is just how sincere this is, how rooted in actual belief and not just hatred of President Obama.

There is something qualitatively different about today’s Republicans. Measurements show that this is the most conservative the Republican Party has ever been, and there is a note of commitment in the way they demand cuts to food stamps or unemployment benefits. They do seem to really believe in the poor kicking agenda, in a way that might last into another Republican administration.

On the other hand, the ideological fervor of the Republican base tends to be by far the strongest when there is a Democrat in the White House. Deficits were no problem during George W. Bush’s term, but The End of Freedom today. During the next Republican administration, the Tea Party will surely settle down as they settled down during the Bush days. It’s pretty easy to imagine a bunch of state-level Tom DeLays pushing through quiet Medicaid expansions on behalf of the local medical industry, covered by the more dimwitted and/or hypocritical of the conservative pundit class, who will conveniently forget this had anything to do with that one Obama guy. And historically, if there’s one thing that has consistently challenged poor-kicking for the top of the Republican agenda, it’s directing subsidies to the top of the income ladder.

So overall, if I had to guess, I’d say that the Medicaid expansion will eventually go through in red states, in some form or another—but probably mediated by as many layers of private-sector grifting as Republicans can possibly dream up. Come 2017, we may find this out first-hand.

Ryan Cooper is a National Correspondent at The Week, and a former web editor of the Washington Monthly. Find him on Twitter: @ryanlcooper

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