It may have slipped your notice, what with the thrill-a-minute nonsense of the 2016 presidential race, but Republicans in Congress are still trying to repeal Obamacare. It’s not a real “repeal” – they’re trying to pass a filibuster-evading measure using budget reconciliation that they fully expect to be vetoed by President Obama. The entire point of the exercise to force Obama to veto it so they can prove to America that repeal can happen if they give Republicans control of Congress and the White House. But even in trying to pass this symbolic measure, they’re running into some snags – some Republicans don’t want to take away their constituents’ Obamacare, even if it’s only for pretend.
One of the key features of the Affordable Care Act is its expansion of Medicaid, which the Supreme Court allowed states to opt out of in 2012. Several red states that flatly refused to expand Medicaid have since overcome their opposition and either accepted the funds from the federal government or obtained waivers from the Department of Health and Human Services to “experiment” with different ways to implement the program. As it stands right now, 30 states and the District of Columbia have expanded Medicaid in some way, and blood-red Utah is in talks to become the 31st. Lots and lots of low-income people have obtained access to healthcare as a result of this steady expansion.
And that explains why Republican senators who represent states that expanded Medicaid are suddenly having reservations about passing legislation that would take that coverage away. As the Hill reports this morning:
“I am very concerned about the 160,000 people who had Medicaid expansion in my state. I have difficulty with that being included,” said Sen. Shelley Moore Capito, a Republican from West Virginia.
Sen. John Hoeven (R), who represents North Dakota, where an estimated 19,000 people gained access to Medicaid after Republican Gov. Jack Dalrymple decided to broaden the program, said he was unsure about repealing the expansion.
“We’ve started to talk about it but we haven’t gotten into it in depth,” he said. “I’m going to reserve judgment until I see exactly what we’re going to do.”
“I respect the decision of our legislator and our governor on Medicaid expansion,” said Sen. Steve Daines (R) of Montana, which has a Democratic governor. “I’m one who respects their rights and voices.”
The biggest hurdle to these Obamacare repeal bills has always been the fact that Obamacare, whether Republicans want to acknowledge it or not, is working. Because of the law, people are getting insured. If you take away the law, you’re taking away their newly obtained health security, which obviously won’t be very popular. This problem is only compounded by the fact that we’re closing in on year six of the GOP’s “Repeal and Replace” crusade and the party still has not coalesced around a replacement plan for Obamacare.
To pass this repeal measure through reconciliation puts Republicans in a tough spot: they can spare some of the more popular parts of the ACA and risk bringing down the ire of hardline Obamacare opponents and conservative activists, or they nuke the whole thing and tell constituents “we’re taking away your coverage and offering nothing in return.” It feels safe to assume that anything but a full repeal measure would be rejected by the House, so the Senate’s hands might be tied if they want to get anything through to Obama’s desk.
This same dynamic is playing out for real in Kentucky, which has been one of the ACA’s biggest success stories. Newly elected governor Matt Bevin promised to end Kentucky’s state-based Obamacare exchange and do some as-yet unspecified amount of violence to the state’s expanded Medicaid program. Going through with that will inevitably result in stripping people of health coverage. The GOP is finally being forced to grapple with the human and political cost of undoing the Affordable Care Act.