Pro-Medicaid GOP governors well placed for reelection
Politico February 25, 2015
Conservative activists threatened revenge for Republican governors who boosted Obamacare. Now it looks like they were mostly blowing smoke.
Around the country, Republicans who defied the base and embraced Obamacare’s massive expansion of Medicaid are better positioned for reelection than those who did not. None has garnered a serious primary challenge so far, and even Democrats have struggled to field strong contenders to take them on.
Govs. Rick Snyder in Michigan, John Kasich in Ohio, Susana Martinez in New Mexico, Bill Haslam in Tennessee and Terry Branstad in Iowa each embraced some form of Medicaid expansion, accepting federal Obamacare cash to cover their low-income population. Each of those governors is now considered the front-runner for reelection this year.
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In Nevada, Gov. Brian Sandoval may not face a significant challenge from the left or the right, even though he’s the sole Republican governor to back both the Medicaid expansion and a new state-run health insurance exchange.
In contrast, several governors who have stood in the way of expansion have found themselves skewered by the left.
To some conservatives, it’s the establishment going soft once again, running counter to the intense anti-Obamacare message at the heart of the national GOP’s drive to keep the majority in the House and win control of the Senate.
But to those governors who broke ranks — many of whom talked about the dynamics over the weekend as they attended the National Governors Association meeting in Washington — it’s a sign that their constituents care less about the political rhetoric than the opportunity to take a big pile of federal cash to cover their state’s poor.
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“There’s still some people upset, but you put it in context,” said Michigan’s Snyder, who characterized his relationship with the base as reasonably good. “The Affordable Care Act was probably among the most polarizing issues you could find in the last decade. What you found is people both went to their corners and said either ‘I hate it’ or ‘I embrace it,’ rather than saying, ‘It’s the law, so … how do we have to address it?’”
The 2010 law initially envisioned expansion nationwide, but the Supreme Court ruled in 2012 that states must have a choice. Some Republican governors balked, worrying that the feds would slash funding down the road, leaving states with the bill. Others could not resist the infusion of federal cash. A few, like Kasich, talked about covering the poor as not just a fiscal, but moral, imperative.
Conservatives are still furious at these governors for lending a bipartisan sheen to even a piece of Obamacare, particularly while it’s still such a red-hot issue in so many Senate races. But they’re not taking a throw-the-bums-out approach to the wayward governors.
Americans for Prosperity President Tim Phillips quoted Ronald Reagan’s old saying: An 80 percent ally isn’t a 20 percent traitor.
“It means we don’t write them off when they’ve done a lot of good things,” he said.
In Nevada, Sandoval has butted heads with leaders of the state Republican Party, which is dominated by libertarians loyal to Sen. Rand Paul (R-Ky.). The governor has refused to participate in a reelection endorsement process that would be controlled by party activists, confident he will easily prevail in a June 10 primary. The vast majority of Nevada Republicans approve of his job performance, and his work on health care has expanded his appeal to independents and moderate Democrats.
“The decision came down to the fact that the number of uninsured individuals we had, this was an opportunity to get them insured,” said Sandoval. “There are some that aren’t happy with that.”
In Ohio, tea party groups promised to field a primary challenger against Kasich,whom they supported four years ago. They recruited an activist who declared that Medicaid would be a defining issue — and then withdrew a couple of days into his campaign. The filing deadline passed without even token opposition. Some of Kasich’s antagonists now hope Libertarian candidate Charlie Earl, a former GOP state representative, will siphon off votes. But polls show Kasich well positioned to win a second term. And his determination to get the expansion despite strong opposition in the state legislature softened his image with independents.
Haslam is considered a shoo-in for reelection in Tennessee this year even though he’s still trying to get some kind of Medicaid expansion compromise through his resistant, GOP-controlled Legislature. He’s looking at something along the line of the Arkansas “private option,” which uses federal dollars to buy Medicaid-eligible people private health plans in the Obamacare health insurance exchange.
“There are days when I think we can get it done and days when I feel like we’re miles apart,” he said, “but I think it’s too important to give up on.”
Iowa’s Branstad, also considered a heavy favorite for reelection, passed what he calls “a reasonable compromise” through a divided Legislature. He too championed an Arkansas-style system.
“It’s an uneasy compromise, and we’ve got to be able to prove that it works,” Branstad said.
Utah Gov. Gary Herbert, another Republican who recently announced support for some form of Medicaid expansion, said his detractors “don’t understand the issue” but predicted they will eventually come around.
It doesn’t hurt that Republicans embracing Medicaid expansion have twisted themselves into pretzels to separate their efforts from Obamacare, even though the expansion is a key plank of the federal health law. They routinely insist that their plans aren’t connected to the health care law, which they say they despise, but rather are a reflection of local priorities and unique circumstances. Each state has policy nuances that set them apart and titles that distance them from the president’s legislation.
In Michigan, Snyder calls Medicaid expansion “Healthy Michigan.” In Iowa, it’s the “Iowa Health and Wellness Plan.” Indiana Gov. Mike Pence supports expanding Medicaid through his state’s existing “Healthy Indiana Plan.” Gov. Tom Corbett recently proposed “Healthy Pennsylvania,” a Medicaid expansion plan still awaiting federal approval. Arizona Gov. Jan Brewer, who is not seeking another term, calls it a “restoration” of Medicaid eligibility to levels that Arizona had previously approved.
There’s also safety in numbers. A few prominent governors who backed Medicaid last year, specifically New Jersey’s Chris Christie and Florida Gov. Rick Scott, set a precedent and made it a little easier for others to follow.
Scott, a former hospital executive who swept into office in 2010 on a vehemently anti-Obamacare platform, is the rare Republican backer of expansion who has failed to persuade his legislature to go along. Unlike Brewer and Kasich, Scott didn’t keep pushing when his party failed to reach a compromise in the Legislature. Nor was he as vocal about his support after the initial announcement. His opponent in 2014, Republican-turned-independent-turned-Democrat Charlie Crist, labels Scott an anti-expansion governor, and he’s made Medicaid a campaign theme.
That Pence, the conservative Indiana governor, has endorsed a version of Medicaid expansion is a sign of how the partisanship has subsided on this specific element of the health law. A former House member, Pence was once one of the most outspoken opponents of the ACA. But on Friday he met with HHS Secretary Kathleen Sebelius — a frequent conservative piñata — about terms for taking the federal money available under Obamacare.
Gov. Jack Dalrymple, who expanded Medicaid in deeply Republican North Dakota last year, said his state’s energy boom and low unemployment muted the politics of Obamacare.
“If we wind up maybe down the road having to pay a share of that, that’s not as threatening as it might be for some other states,” he said.
Perhaps the harshest backlash came in Arizona, where Brewer battled her GOP-led Legislature to get Medicaid done. Although she’s term limited and will leave office after this year, conservatives have branded her and her allies in the state legislature as “traitors” who carry water for President Barack Obama.
Vermont Gov. Peter Shumlin, chairman of the Democratic Governors Association, predicted that GOP governors who took the expansion “will be in somewhat better shape” politically than those who didn’t, such as Maine’s Paul LePage or South Carolina’s Nikki Haley.
“They’re turning those federal dollars down because they don’t like the president or to make a political point,” said Shumlin. “Those folks are going to be punished at the polls.”
Even if Republicans who embraced expansion escape political peril in 2014, those eyeing a 2016 White House bid could find themselves in the conservative cross hairs.
For example, Wisconsin Gov. Scott Walker and Louisiana Gov. Bobby Jindal, who rejected expansion, may take on Christie, Kasich or Snyder for going soft.
For now, Walker avoids criticizing his colleagues. He jokes that “some activists” will always be upset about any controversial decision.
“Even when I first announced [my version of health reform], there were people who didn’t fully understand what we were doing,” he said. “When I said we were ‘making sure everyone who is living in poverty is covered,’ somehow people thought that was a Medicaid expansion. I’m like, ‘No! I didn’t take the expansion! I was just creative in how I covered people living in poverty.’”
Democrats see the split among Republicans as a sign that establishment Republicans are at war with their tea party brethren.
“You can hate Obamacare. You can fuss about all the Washington stuff you want to,” said Arkansas’s Democratic Gov. Mike Beebe, who is still struggling to keep the expansion alive over objections of some state Republican lawmakers. “At the end of the day, you’re not going to change that in the state legislature. The traditional Republicans understand that and agree with that. They can still rail against Obamacare and recognize the pragmatic need to expand Medicaid.”
North Carolina Gov. Pat McCrory, not up for reelection until 2016, has not expanded Medicaid, partly because of strong opposition from fellow Republicans in the state Legislature. He said it’s a tough topic to message.
“The public, frankly, doesn’t know the difference between Medicaid and Medicare,” he said. “The dilemma you have is when you have a headline saying, ‘Governor refuses Medicaid expansion,’ it sounds like you’re impacting existing Medicaid. So the headlines are very deceptive, and the general public is going, ‘What do you mean you’re against Medicaid?’ No, we’re for Medicaid.”
National Governors Association Chairwoman Mary Fallin, who says there is “no appetite” for expansion in her state of Oklahoma, said Republican governors who have pursued expansion undoubtedly irked some of their base. She said activists thank her for standing firm when she travels out of state.
“They’ll say, ‘We’re proud for you hanging in there,’” said Fallin. “But each governor has to do what’s best for their state.”