Monday, July 2, 2012

What "ACA Medicaid-gate" Is Really About

So Nevada is finally entering the civilized world...

But not fully. Certainly, it's a start that the state is implementing the biggest component of the Affordable Care Act. However, the state is still threatening to blow up the proposed Medicaid expansion that's necessary to cover another 91,000 Nevadans, move us closer toward a truly universal health care system, and ultimately lower health care costs for everyone. Funny enough, Brian Sandoval and some shortsighted legislators are complaining about the cost!

Well, supposedly they're concerned about "the cost". In reality, I suspect they're really afraid of the "tea party". Yes, I said it. This is really about politics.

The response from Republican governors and state legislators has been predictable. Essentially, the court handed Republican politicians a high-profile opportunity to define themselves in opposition to President Obama’s signature accomplishment, a law for which their party’s has particular contempt. So there’s an element of posturing here. The question is how many GOP governors and state legislatures will ultimately relent and take the federal money.

Logic says that most, if not all, of them will. After all, the federal government is offering a pretty good deal to the states, and some powerful interests –hospitals that now end up providing free emergency care for patients who would be eligible for Medicaid under the expansion and insurance companies offering Medicaid managed care plans –figure to exert considerable pressure on state leaders to go along. Particularly for a governor like Christie, who leads a blue state and is facing reelection in 2013, it might not take much pressure to convince him to implement the expansion.

That said, the value to an ambitious Tea Party-era Republican politician of defying the Obama administration and rejecting money from Washington shouldn’t be underestimated. Since Obama came to office, we’ve seen Jindal make a show of turning down stimulus money for his state, Christie blow up a long-planned and badly needed rail tunnel, and Scott turn down federal dollars for high-speed rail, to cite a few examples. Whether these sorts of stunts play well with general election audiences is debatable, but within the GOP, they’re winning moves.

Intraparty Republican politics, in other words, are the main threat to the ACA’s Medicaid expansion. Right now, a Republican elected official at the state level who signals his or her readiness to expand the Medicaid rolls is giving ammunition to a potential primary challenger from the right –a threat that every Republican office-holder has to take seriously in the Tea Party-era.

How else can one explain denying health care to at least 91,000 Nevadans? How else can one explain driving up health care costs for everyone by continuing to force people to use the emergency room as "primary care"? And how else can one explain "half ass-ing" health care reform?

Oh, and one more thing: They're already mad that the state is implementing the health insurance exchanges. And for teabaggers, that may be "sinful" enough for them to consider Sandoval even more of an "apostate". Really, they're already punishing him for challenging Grover Norquist orthodoxy. Funny enough, he was supposedly doing this because he wanted to avoid education cuts AND fully comply with the Affordable Care Act. Whatever happened to that?

Since Nevada has already begun to implement the Affordable Care Act, it only makes sense to fully comply and accept the expanded Medicaid program. More Nevadans will have the health care they need, and the new system will ultimately work better for everyone. And in the end, neither progressives nor "tea partiers" (or even those in the middle, for that matter) will appreciate "half ass-ed" health care reform.

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