It’s fair to say that Indiana Gov. Mike Pence has thrown Obamacare politics for a considerable loop. Pence, a staunch conservative and opponent of the Affordable Care Act, plans to use money made available by the ACA to expand Indiana’s program for insuring low-income residents. Pence will deny up and down that he’s made himself a party to Obamacare, but federal money flowing into Indiana to provide health coverage for Hoosiers would make those denials fairly hollow.
The governor is already taking heat from conservatives who say he’s betraying conservative principles and not being forthright about it (an on-point critique!), but Pence’s apostasy could have ramifications beyond ticking off a few Heritage Foundation fellows.
Pence is not the first conservative leader to ask for Obamacare funds to expand health coverage in his state. John Kasich, Chris Christie and Jan Brewer all expanded Medicaid in line with the Affordable Care Act’s original intent. Other Republican governors have successfully implemented customized expansion programs, like Terry Brandstad in Iowa and Rick Snyder in Michigan.
Pence is different, though. He’s a conservative darling with well-established ambitions to run for the presidency. And he’s mapping out a strategy to claim the benefits of Obamacare while purporting to keep the law at arm’s length. That strategy requires a fair bit of willful obtuseness and chutzpah – his office’s announcement of the expansion plan claims that it “will alleviate the coverage gap created by the Affordable Care Act,” even though it was Pence himself who created that gap when he chose not to expand Medicaid. But that’s largely beside the point.
When a committed and high-profile Obamacare foe like Pence indicates he’s going to find a way to work within the new reality of the Affordable Care Act, he’s doing two things. First, he’s making the die-hard “repeal Obamacare” crowd look unreasonable. If Mike Pence can learn to live with the ACA, then anyone can. Second, he’s sending a message to Republican leaders in other states that it’s possible to take advantage of the law’s benefits while saving face as a small-government conservative. As the New York Times’ Aaron E. Carroll put it: “If Mr. Pence can find a way, it’s likely some of the 23 holdout states will eventually follow.”
People who support expanding healthcare access to as many people as possible will happily overlook Pence’s hypocritical shadowboxing routine and welcome some 350,000 low-income Indiana residents to the ranks of the insured. But for conservatives who resent Pence for giving up the ghost, this is a problem.
Specifically, it’s a problem for Republicans who still hope to make the Affordable Care Act a deathly toxic issue for Democrats in 2014. Yes, the issue has receded lately as a streak of ACA victories sucked the wind out of the anti-Obamacare movement, but it will return in time for Election Day. If the feds give Pence the thumbs-up to go ahead with his expansion plan, Republican candidates fulminating against the law could find themselves asked to explain why they can’t tolerate Obamacare when the ultraconservative governor of Indiana found a way.
Looking beyond the 2014 elections, the question of anti-Obamacare activism gets even thornier. The conservatives at the Federalist credit Pence with making Medicaid expansion a national issue for 2016:
Two camps are emerging among GOP governors: those who oppose the Obamacare expansion, and those who pretend to. Pence has now officially joined the pretender camp.
While senators who aspire to be president can easily duck the Medicaid issue by simply opposing Obamacare in toto, gubernatorial aspirants like Pence cannot. Medicaid is a state-run program (albeit with a lot of federal funding and red tape) and is the largest item in most state budgets. More importantly, it’s a state-level hot potato these days, thanks to Chief Justice John Roberts’s 2012 decision to make the Expansion optional for states.
How governors handle this particular hot potato reveals a lot about their governing philosophy and their views on health care, balanced budgets, and federalism.
If Pence does indeed decide to run for president, his use of federal money to expand health coverage would be an obvious point of contention in the Republican primaries. If he succeeds in reducing the ranks of the uninsured in his state, would he run on that accomplishment, or would he fall victim to accusations of colluding with Barack Obama’s big government agenda? Would the dreaded RINO label prevent him from even making it to New Hampshire and Iowa?
The answer will depend largely on how long Obamacare retains its potency as a political issue. By moving to embrace the Affordable Care Act – albeit as cynically and backhandedly as possible – Pence is actually helping ensure that anti-Obamacare sentiment does not endure.