For Republicans in Congress are finding themselves in the awkward position of arguing against the Affordable Care Act and its expansion of Medicaid coverage at the same time that Republican governors in their states are striving to extend the programs to thousands of additional residents – and voters.
Republican governors in a dozen states want to expand Medicaid under the ACA, have already expanded it, or are defending past expansions by prior governors, New York Times reporter Robert Pear noted in an analysis of the split in the GOP ranks.
One example cited in his article was the vote in early December of 2015 by Republican Sen. John Thune of South Dakota in favor of repealing key parts of the health care law and the expansion of Medicaid.
Later that month, his state’s Republican governor, Dennis Daugaard, urged legislators to expand Medicaid to cover 55,000 more residents of the state.
“In state after state, a gulf is opening between Republican governors willing to expand Medicaid coverage through the Affordable Care Act and Republican members of Congress convinced the law is collapsing and determined to help it fail,” Pear wrote.
States whose Republican governors have taken positive positions on Medicaid expansion include Arizona, Arkansas, Indiana, Iowa, Michigan, Nevada, New Jersey, New Mexico and Ohio, the article points out.
Republic governors in South Dakota, Tennessee and Utah are negotiating with their state legislators about expanding Medicaid. Robert J. Bentley, the Republican governor of Alabama and a physician, and a former opponent of the health care law, is reexamining his position, according to the article.
The split is “a reflection of the larger fight in the Republican Party between more pragmatic Republicans, including governors, and the ideological wing of the party that wants to stop Obamacare at all costs,” healthcare policy researcher Joan C. Alker told the newspaper. Prof. Alker is Executive Director of the Center for Children and Families and its Health Policy Institute at Georgetown University, who has testified before Congress on health issues a number of times.
A conservative strategist explained the divide among Republicans differently. Tarren Bragdon, founder and president of the Foundation for Government Accountability, told The Times that both Republican and Democratic governors regard the federal funds available to expand Medicaid as “free money.” Republicans in Congress object to the impact of this spending on the federal budget and “believe that the expansion of Medicaid will not be sustainable or affordable in the long term.”
One GOP member of Congress facing that conflict is Arizona Sen. John McCain, the article notes. More than 78,000 additional Arizonans are covered by Medicaid since it was expanded in 2013 by then-Governor Jan Brewer. The current Republican governor, Doug Ducey, is negotiating with the federal government to modify the program but not to unwind the expansion.
Despite Sen. McCain’s vote in July of 2015 to repeal of the ACA, at the state level “I am very reluctant to take positions that counter the decisions made by the governor,” he told the newspaper