Bashing “Obamacare” just isn’t what it used to be.
Just over two years ago, the rallying cry against President Obama’s health care overhaul unified Republicans and hoisted the party to historic electoral gains in state capitals and in Washington.
But in the latest sign the script has flipped, Florida Gov. Rick Scott — who rode that tea-party-fueled crusade to victory in 2010 — this week became the seventh Republican governor to agree to the new law’s Medicaid expansion. Cracking the opposition is the weight of the Supreme Court’s decision in June to uphold most of the law, Obama’s electoral triumph in November, and the grudging acceptance that the law is here to stay.
Resistance to parts of the law is also waning as the GOP seeks to revamp its image as the party of the privileged and appeal to fast-growing minority communities that face disproportionately bigger insurance gaps. States that expand will offer health coverage to everyone earning below 133 percent of the federal poverty level — about $15,000 for a single person — and those that don’t will leave that population out in the cold.
“I cannot, in good conscience, deny the uninsured access to care,” said Scott, one of the most unpopular governors in the country facing reelection in 2014. “Expanding access to Medicaid services for three years is a compassionate, commonsense step forward.”
Then there’s the math: As firebrand candidates who decried bigger government during campaigns transition to being executives dealing with state budgets, the federal money that comes with the Medicaid expansion is tempting. In the first three years, the federal government pays all of the costs for the new population. As Scott and other Medicaid-welcoming GOP governors have pointed out, refusing the federal money would mean local taxpayers would be subsidizing coverage in other states. Expanded Medicaid is also a huge boon to the politically powerful health care industries, which have lobbied aggressively for Medicaid money to balance their books and tend to be the largest employers in many communities.
“It’s a lot easier in the abstract to be dogmatic, but it’s really hard when you’re governing,” said Republican strategist Susie Wiles, who ran Scott’s campaign. “The awareness that Obamacare is the law of the land and that the president was reelected pretty resoundingly is calming the saber rattling.”
While the country has always been sharply divided on the sweeping health care law, individual provisions, including the Medicaid expansion, are popular. A recent survey conducted for the American Cancer Society showed that 63 percent of Floridians say yes when asked if their state should accept federal funds to expand the program, compared with just 25 percent who are opposed.
And polling from the Kaiser Family Foundation found 52 percent of adults nationwide favored expansion. When Kaiser’s pollsters offered arguments in favor of expansion — like the fact that rejection would eliminate funding for local hospitals and doctors — approval jumped another 12 percentage points. Those numbers are likely to weigh on politicians as the law starts to be implemented and become more concrete in voters’ lives.
Add the political context that five of seven Republican governors who have accepted the Medicaid money represent swing states that backed Obama: Scott, Nevada Gov. Brian Sandoval, New Mexico Gov. Susana Martinez, Ohio Gov. John Kasich, and Michigan Gov. Rick Snyder. The Republicans who have resisted federal intervention include two potential presidential candidates from battleground states — Virginia Gov. Bob McDonnell and Wisconsin Gov. Scott Walker — as well as possible red-state contenders such as Louisiana Gov. Bobby Jindal. One key governor to watch for a decision is New Jersey’s Chris Christie, a Republican who faces reelection in his Democratic-leaning state this year as well as the temptation of a presidential bid in 2016.
The reversal by Scott will give political cover to other wavering Republican governors, though many health care consultants steeped in state politics have been predicting mass adoption of the Medicaid expansion all along.
“There is so much money on the line, and it would be so devastating to the hospitals and the safety-net providers in the state if they don’t expand,” said Caroline Pearson, a vice president at the consultancy Avalere Health, who was not surprised by Scott’s announcement. “My count is that we’ve got 17 now that have said for sure that they’re not going to expand. And if I had to guess, we end the year with five to 10 that don’t expand.”
In an effort to keep the faith, the Republican governors who have accepted Medicaid funds have emphasized their continued opposition to Obamacare overall. Florida opted against running its own insurance marketplace next year, for example.
“It is not a white flag of surrender to government-run health care,” Scott said on Wednesday. “I’ve never been a supporter of the Affordable Care Act,” Brewer noted in her Medicaid expansion announcement in January. But the Medicaid expansion is the most painful part of the health reform law for governors to resist, both financially and politically.
The Obama administration, for its part, has been trying hard to persuade governors to come on board. Early after the Supreme Court decision, officials clarified that there would be no deadlines for Medicaid expansion and that it wasn’t permanent. Health officials have also been offering inducements, by humoring requests for changes to existing state Medicaid programs. On Wednesday, Scott declared victory on a long-sought approval for a plan to move more Medicaid recipients into private health plans. Ohio Gov. John Kasich, another Republican, has said that the White House has made promises that it will approve his reform plans, too.
“If you take out the partisanship and the tea party and you look at the facts, as long as you believe the federal government will follow through on its commitment, Medicaid expansion makes sense,” said Michigan pollster Edward Sarpolus, who has researched the issue and tracks the govenor’s approval ratings. “He [Snyder] appears to be conservative, but he’s much more of a pragmatist.”
Notice how some of the Republican governors acquiescing to bigger Medicaid programs — even those who campaigned on their party’s traditional anti-big-government, pro-free-enterprise themes — are adopting the bleeding-heart rhetoric frequently associated with liberal Democrats.
Scott made it personal by talking about his late mother’s struggles to raise five kids, including one son with a hip disease. So did Kasich in his State of the State speech last month, invoking his religious faith and lamenting the plight of addicts and mentally ill people living on the streets.
“For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored,” he said, adding a plea to lawmakers to “please examine your conscience.”
These appeals are a departure from the tough talk associated with Republican presidential nominee Mitt Romney, who suggested “self-deportation” for illegal immigrants and was caught in a private fundraiser dismissing the nearly half of Americans who depend on some form of government assistance as freeloaders.
“There no question that Republicans should look at the kind of language Kasich is using as a model and an effective way to communicate because the party’s brand does need some work,” said Ohio-based Republican strategist Curt Steiner, who worked as chief of staff for former Gov. George Voinovich.
Another reason for Republicans seeking to broaden the party’s tent to reconsider the health care law: It’s popular in the Hispanic community, the fastest growing part of the electorate. An ImpreMedia/Latino Decisions poll on the eve of last November’s election found that 61 percent of respondents thought Obamacare should stand and 66 percent thought the federal government should make sure everyone has health insurance.
After seven out of 10 Hispanic voters rejected Romney in November, Republican Party leaders are increasingly calling for better outreach and praising Capitol Hill for taking up immigration reform.
But Medicaid expansion is not a done deal in Florida and other states where Republican-led legislatures are leery of conservative activists who remain hostile to Obamacare. It’s the same chasm between the pragmatic political establishment and the more ideological grassroots that’s emerging in the national debates over the federal budget, immigration reform, and other social issues. The Wall Street Journal editorial board, acting as a top enforcer of the anti-Obamacare orthodoxy, has slammed Scott, Brewer, and other state executives who are cooperating with the president.
With one recent poll pegging Scott’s approval rating at just 33 percent, it’s even possible that the sitting governor could draw a primary challenge.
“The grassroots hasn’t brought out the pitchforks and torches out yet, but they certainly want an explanation from Governor Scott,” said Peter Feaman, Florida’s Republican national committeeman. “I’m getting e-mails expressing serious concerns and I think the grassroots will put a lot of pressure on the Legislature to stay strong.”
CORRECTION: The graphic accompanying this story originally referred to Medicare expansion. The states are considering expansion of the Medicaid program, not Medicare. The graphic has been updated.
This article appears in the Feb. 22, 2013, edition of National Journal Daily.