Yesterday morning, Mike Pence, the conservative Republican governor of Indiana, stood behind a lectern at an Indianapolis hospital, opened his arms wide, and gave a big ol’ bear hug to big-government socialist tyranny. Well, sort of. Pence will never admit it, but yesterday he became just the latest red state governor to sign on to the Affordable Care Act’s expansion of Medicaid. Pence is casting the move as “Medicaid reform,” which is an ungraceful bit of spin that lets him avoid saying he just accepted millions of dollars in Obamacare money.
First off, this is good news for Indiana’s lower-income residents. Pence worked out an agreement with the Department of Health and Human Services in which Medicaid expansion funds will be used to expand an existing state health coverage program. To receive benefits under the expanded program, enrollees will have to make monthly contributions (between $3 and $25) to HSA-like accounts, and if they miss a payment they could lose their coverage for six months. This is obviously quite a departure from traditional Medicaid, but Pence was never going to agree to no-strings expansion of the program. There are some real drawbacks to tweaking with Medicaid in this way, but expanded access to health coverage paired with small mandatory monthly payments is better than nothing.
Pence’s embrace of Obamacare puts conservatives in an extraordinarily awkward position, and you’ll find no better proof of that than the statement put out by the Indiana chapter of Americans for Prosperity in response to Pence’s announcement. AFP typically goes to war on Republican governors who cave to the Medicaid expansion (Michigan’s Rick Snyder can attest to that), but for Pence, they’re opting for a different tack:
“While Governor Pence’s attempt to reform traditional Medicaid is laudable, our concerns with HIP 2.0 remain,” explained Chase Downham, Indiana state director of Americans for Prosperity. “Traditional Medicaid needs to be reformed, and states should be free to pursue market-oriented solutions that will help to modernize the program. However, the price of reforming traditional Medicaid should not come at the cost of expanding an already troubled entitlement program to include hundreds of thousands of able-bodied, working-aged, childless adults. Hoosiers believe in the dignity of work and desire the prosperity that comes with a job opportunity, not more government-funded health care.”
AFP hates Obamacare and never misses a chance to attack it in the harshest terms possible. But the Koch-funded small-government group also loves Mike Pence, who has a long and fruitful relationship with the Koch empire and was positioned to be their pony in the 2016 presidential race. So rather than flay him as a corrupted agent of Obama liberalism, they pat him on the head for his “laudable” intentions while knitting their brows over the price tag.
Other conservatives aren’t as willing to cut Pence so much slack. The Washington Examiner’s Philip Klein called Pence’s attempt to frame the move as Medicaid reform “merely window dressing,” adding: “Any plan that expands the Medicaid program imposes more costs on taxpayers, expands the federal role in healthcare and should be passionately opposed by those who care about the nation's future.” National Review called Pence’s move “disappointing” because “Pence was one of the rare conservatives who stayed loyal to his free-market principles when he was in Congress during the Bush years.”
The reason these conservatives are so upset with Pence is precisely because he’s a longstanding icon of modern conservatism. The fact that he is – in their eyes – capitulating to the Obama welfare state is bad enough, but he also sends a signal to every other conservative, red state governor out there that a way can be found to take advantage of all that ACA money while still maintaining a posture of “Obamacare” resistance. One of the biggest effects of Indiana’s acceptance of Medicaid funds could be that it causes Republicans in states with huge numbers of people in the Medicaid coverage gap (Texas, Florida, etc.) to rethink their blanket opposition to the ACA.
Conservatives are adamant that Republicans at the federal level remain in unwavering opposition to the ACA because they don’t want the GOP to be a party to any Obamacare “fixes” that will put Republican fingerprints on the law. Meanwhile, at the state level, Republicans are undermining that resistance by embracing the law and showing that the White House will compromise with the GOP on healthcare reform. And as each new state comes around, the hardcore Republican resistance to the Affordable Care Act seems less and less reasonable.