GOP Slowly Accepting Medicaid Expansion

When the Supreme Court upheld the individual insurance mandate of the Affordable Care Act, conservatives' disappointment was tempered by one element of the ruling, which allowed states to opt out of the ACA's expansion of Medicaid. Obamacare might have survived, but at least they'd be able to stick it to poor people. The Medicaid expansion was perhaps the most critical part of the ACA, potentially delivering insurance to 30 million people who don't have it, but now Republican governors and Republican legislators would have a chance to give Barack Obama the finger and refuse to accept the giant pot of money the federal government was offering to insure their poorest citizens. (Though Medicaid funding today is split between the federal government and the states, the feds will pick up almost the entire cost of the expansion). Ironically, the states where Republican rule is firmest stood to gain the most, since they're the ones with the stingiest existing Medicaid eligibility standards, who would therefore see more people insured under the new rules.

When the Court's decision came down and Republican governors began declaring their intentions to spurn the funding and let their poor citizens remain uninsured, many predicted that once the checks started to get written, they'd come around. Unfortunately, the governors of some states with the largest uninsured populations—including Rick Scott in Florida and Rick Perry in Texas—are still holding out. But today, Ohio governor John Kasich announced that his state would be accepting the Medicaid expansion. Apparently, the fact that the federal government was picking up all the cost, plus analyses indicating that the state would reap further financial benefits from a population without so many uninsured (less uncompensated care for which the state eventually picks up the tab, increased tax payments from more productive workers and businesses, and so on) made it too good to pass up. There's also the moral question of allowing thousands of your citizens to get health coverage, of course, but Kasich didn't seem too concerned with that. In any case, he joins the Republican governors of Nevada, New Mexico, North Dakota, and Arizona in accepting the expansion. Hopefully he won't be the last.