At this point it’s near-impossible to maintain the fiction that the Affordable Care Act is failing or that the Republicans have a coherent strategy for unmaking it. One by one, Republican-led states are abandoning their opposition to implementing the ACA. Last week, Pennsylvania Gov. Tom Corbett became the latest Republican to officially give up the anti-Obamacare ghost when he reached an agreement with federal regulators that will allow the state to expand Medicaid, clearing the way for roughly half a million low-income people to receive health coverage. Shortly afterward, news broke that Tennessee’s Republican governor, Bill Haslam, is working on his own proposal to bring expanded Medicaid funding to the state. Socialism: It creeps.
This is obviously an unwelcome trend for groups like Americans for Prosperity, the Koch brothers’ main outlet for political activism. AFP has been leading the anti-Obamacare charge among outside groups, arguing that expanding Medicaid is a bad idea because the program is broken, and that the feds can’t possibly keep their promises to provide the required funding. “Expanding medicaid [sic] would have disastrous consequences in Maine,” AFP declared in June. “Medicaid is a broken system that offers poor quality care to those who often need it most, and the promise of new funding from the federal government is as close to being broken as the next Washington budget crisis.”
That sounds pretty bad! One would assume that wherever the specter of expanded health coverage for poor people looms menacingly, AFP will be there fighting hard to make sure states don’t fall into the trap, right? Well, sort of. As it turns out, it depends on the state. Or, to put it another way: It depends on the governor.
Among the growing ranks of Republican governors who are signing on to the Affordable Care Act’s Medicaid expansion is Indiana’s Mike Pence. His plan to use federal Medicaid dollars to expand an existing state health program for low-income residents is currently awaiting approval by the Department of Health and Human Services (Pence traveled to D.C. to pitch the plan to Health and Human Services Secretary Sylvia Matthews Burwell in July). He’s taken no small amount of grief from conservatives who feel that Pence is selling them out and being dishonest about it by snapping up federal money made available by the ACA while still claiming to oppose the law.
AFP is among the conservative groups that registered their disapproval with Pence’s plan – their very measured, carefully worded, heavily diluted disapproval. Dig through AFP Indiana’s website and you’ll find one statement on the Pence plan, released on May 30 (two weeks after the plan was unveiled). The plan “misses the mark” and should “cause concern,” the statement reads, before transitioning to excuse-making and praise for the guy proposing it:
We Hoosiers have a long tradition of embracing fiscal responsibility and shunning away from large, expansive government programs. Throughout his time in Congress and as the Hoosier state’s chief executive, Governor Pence has been a champion for federalism, and he no doubt attempted to hold that line in rejecting traditional Medicaid expansion and insisting that HIP be part of any Medicaid discussion.
Yet, rather than meeting Washington’s demands, states should be given the ability to truly reform their own Medicaid programs with no-strings attached federal block grants – a sensible solution that many including Governor Pence were advocating for long before President Obama’s disastrous law was thrust upon the American people.
Since then they’ve been pretty quiet on the subject.
Now contrast AFP’s treatment of Pence with how the group reacted to Rick Snyder, the Republican governor of Michigan, when he backed Medicaid expansion in his state in early 2013. Snyder’s plan was also a compromise measure that required HHS approval – it puts in place co-pays and premiums (based on income) for recipients and incentivizes healthier lifestyle choices. AFP Michigan opposed the plan from the get-go.
One week after it was announced, AFP released a “letter of support” to state senators who proposed legislation blocking the expansion. “The federal government cannot afford these excessive obligations,” the letter said. “Governor Snyder is breaking his promise to provide excellent customer service to the people of Michigan by placing them into a broken system.” They organized social media campaigns against the expansion, attacked Snyder for meeting with then-HHS Secretary Kathleen Sebelius to negotiate the details of the plan, called the proposed expansion “inhumane,” argued that “at best, Snyder’s promises are sincere but misguided,” spent six figures on radio ads opposing the policy, and even threw together some hot-air balloon rides as part of the “Medicaid Expansion, Nothing but Hot Air Tour.”
The expansion measure passed the Michigan Legislature in September 2013, after which AFP named and shamed the GOP state senators who voted for it.
So what explains the disparate treatment? It may be that AFP is finally starting to see the writing on the wall and coming to grips with the slow, steady erosion of the Republican anti-Obamacare bulwark. But it could also be the fact that Mike Pence is the Koch brothers’ golden boy.
Politico’s Ken Vogel and Maggie Haberman reported last week on the deep, abiding, mutual love that Mike Pence shares with Charles and David Koch and their many billions of dollars. Pence staffers from his days in Congress now hold important positions throughout the Koch empire. “Pence may just be among the best — or, at least, the more electable — messengers for this new Koch brand in a field of prospective candidates who fit some portions of the brothers’ political bent but not others,” Politico notes. Pence was one of the guests of honor at AFP’s activist summit this past weekend. If AFP is angling to prop Pence up as its 2016 candidate, it can’t very well go to war with him, even if he is capitulating in the fight that has defined the group's existence over the past four years.
Then again, AFP can’t be seen to be playing favorites either. “We hold [Pence] accountable when we disagree with him,” AFP president Tim Phillips told Politico. “We disagree with his hybrid Medicaid expansion. And we’ve made that clear both within the state to our activist base and to the governor.” That’s true. They did release a statement.