Plenty of attention has been paid to the Republicans governors who are vowing or threatening not to participate in the Medicaid expansion that the Affordable Care Act calls for.
According to a handy list compiled by the Hill, seven GOP governors have gone on record saying they won’t expand their Medicaid rolls, seven more are officially undecided but appear to be leaning toward doing the same, and 15 are simply undecided. None have publicly said they’re for expansion or indicated they’re leaning toward implementing it.
This is no small matter: Making those with incomes up to 133 percent of the federal poverty line eligible for Medicaid is key to the ACA’s vision of near-universal health insurance, so the more states that refuse to take part, the less universal coverage will be. (Maura Calsyn and Emily Oshima have put together an incredibly useful interact map that illustrates how many people each state’s ultimate decision will affect.)
As you might expect, Democratic governors are far friendlier to the Medicaid component of the law, which calls for Washington to fully fund each state’s expansion for three years, at which point states would then become responsible for 10 percent of the costs. So far, 11 Democrats have affirmed their readiness to participate (as has Lincoln Chafee, Rhode Island’s independent governor) and one seems to be leaning in favor of doing it. But there are some holdouts. The Hill lists seven Democratic governors as undecided and one as leaning against expansion.
In most of these cases, it’s not hard to see what’s going on. Take Missouri’s Jay Nixon, the one who’s leaning against. Nixon is a first governor of a red state, one that John McCain managed to (barely) carry against the national Democratic tide of 2008. Presumably, Obama will fare worse in the Show Me State this fall, and Nixon will be seeking reelection on the Democratic ticket with him. So Nixon really has no incentive to embrace the expansion now. In the wake of the Supreme Court’s ruling, the politics of healthcare are raw, especially in a more conservative state like Missouri. Republicans are looking for ways to tie Nixon to the president and his signature law, so why make it easy for them – especially since Medicaid expansion isn’t slated to begin for a few years? It’s a hunch, but chances are a reelected Gov. Nixon would be more enthusiastic about participating than candidate Nixon appears to be.
Most of the undecided Democratic governors also hail from red states. One of them, West Virginia’s Earl Ray Tomblin, will also face the voters this fall and is one of the Democrats to announce recently that he won’t attend his party’s national convention this summer. The same calculation behind that move – Don’t get too close to Obama! – is probably a factor here too. Kentucky’s Steve Beshear, whose state voted for McCain by 16 points in 2008, won’t be up for reelection until 2015 but also has an obvious incentive to keep distance from the president. So does Colorado’s John Hickenlooper, who governs a more Democratic-friendly state, but one that could plausibly flip to the GOP when he seeks reelection in 2014.
Several others on the undecided list (Montana’s Brian Schweitzer, New Hampshire’s John Lynch, North Carolina’s Bev Perdue) aren’t running for reelection this year, but could be trading carefully out of respect for their state parties. Only one of the undecideds, Delaware’s Jack Markell, leads a solidly blue state.
So it’s worth keeping in mind that the incentive for posturing on Medicaid doesn’t exclusively apply to Republicans. But with wobbly Democratic governors, there’s more reason to believe that the posturing involves short-term politics only – not a long-term commitment to resist the healthcare law.