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September 02, 2014 5:17 PM Fresh Out of Humanitarians

By Ed Kilgore

With Pennsylvania having given a boost to Medicaid Expansion Optimism, people are on the lookout for the next Republican-governed state that might go over the line. TPM’s Dylan Scott writes up Wyoming as a likely candidate, since Gov. Matt Mead has been instructed by his legislature to look into some sort of deal with the Obama administration.

Scott does a good job of asking Wyoming figures exactly what might have changed since the state rejected the Medicaid expansion at their first opportunity. As a Democratic legislator made it clear, it’s not like hearts have softened:

“We’ve already got everybody that is susceptible to the humanitarian argument,” he said. “We need new arguments because that didn’t get us enough.”

The fiscal deal is insanely generous, but that’s always been the case. Yes, concerns among hospitals that they’d be in a much worse financial position without the expansion have become tangible, and Scott reports Wyoming hospitals (and presumably some other providers) are pushing for a deal.

But the real clincher, it seems, is getting a deal that conservatives can claim as a policy victory, and there’s some precedent for that:

The administration has already signed off on alternative plans that adopted conservatives policies, like using Medicaid dollars to pay for private health insurance and requiring some enrollees to pay small premiums.

Mead would have every reason to push beyond the concessions already made. I’ve been saying this for a while, but if I were a Republican governor, I’d put together a plan that included every nasty right-wing Medicaid idea ever hatched, and then if it’s approved, I’d brag that I’d tricked Obama into financing conservative health reforms in my state. Right now, with an awful lot of people believing we’re at some sort of tipping point on states agreeing to the expansion, would be a good time to press one’s luck. So I’m not going to get too excited until we’ve seen the terms under which these expansions are happening, if they happen at all.

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.

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