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.”