Three stories I need to highlight from internal Republican political debates:
Politico on the Senate and the reconciliation bill that will get vetoed by President Obama:
To get conservatives such as Lee, Cruz and Rubio on board, the reconciliation bill may have to be changed to dismantle other controversial parts of Obamacare that are untouched in the current bill. Those provisions include the Medicaid expansion and the subsidies provided to millions of consumers who purchase insurance through the Obamacare exchanges.
The current bill that passed the House continues Medicaid expansion. Republicans from marginal districts want to keep Medicaid expansion and subsidies for insurance, they just don’t want to pay for it.
Now a report from Kentucky:
Bevin said his intent is not to cut people off but to customize Medicaid to Kentucky through a waiver – known as a “1115 Medicaid demonstration waiver” – of federal rules on eligibility and coverage. Bevin has pointed to Indiana’s model as an example of the direction he wants Kentucky to head. Medicaid recipients there pay either premiums or co-pays, sometimes both. Ashley Spalding, research and policy associate for the Kentucky Center for Economic Policy, said that would tamp down access to health care.
Kentucky is highly likely to continue Medicaid expansion albeit via a convoluted, more expensive and less comprehensive waiver instead of straight-up expansion that it currently has. The Governor elect first made his name as being a full repeal without replacing Tea Partier reactionary, but he is backing off to expanding Medicaid under PPACA without calling it an Obamacare Medicaid expansion.
And finally from Alabama:
The fight over Medicaid expansion has become one of this decade’s great partisan divides in Alabama. Under the ACA, states were originally intended to expand Medicaid to people with income levels up to 138 percent of the federal poverty level, providing an out for people too poor to meet the law’s requirement to buy health insurance. But Gov. Robert Bentley, like many red-state governors, declined to expand the program, citing opposition to Obamacare and concern about the state’s ability to pay for expansion.
That wall of opposition may be crumbling. As recently as Thursday, Bentley told reporters that he was considering expansion, though he had yet to make a final decision on the issue…
A blue-ribbon task force, assembled by the governor earlier this year to study solutions to the state’s most pressing health issues, may vote this week on a resolution recommending something similar.
“We are considering a recommendation that the governor expand coverage to include as many people as possible,” said Ronald Franks, chairman of the Alabama Health Care Improvement Task Force. Franks said wider health care coverage would likely help the state deal with widespread issues such as diabetes.
Alabama has not submitted a waiver nor has it outlined a waiver application, but given that a major and successful Republican political leader’s spokeswoman did not issue a vehement and clear denial.
These type of discussions and decisions are how programs get entrenched. Opponents are making operational peace with reality as it is instead of how they wish it to be.