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.
BGinCHI
Hopefully extended coverage in Alabama will cover empathy and brain transplants.
Another Holocene Human
I was riding in a car recently with others to from NOLA via MS and AL. Local police were pulling people over on the interstate. Don’t know how that is legal, but hokay.
Only time I feel safe is flying over or taking Amtrak through.
Baud
@BGinCHI:
Who would be the donors?
BGinCHI
@Another Holocene Human: Probably to make sure everyone was armed.
BGinCHI
@Baud: That’s the challenge. It’s a brain and empathy desert for hundreds of miles in all directions.
(raven is going to kill me right after he wakes up)
Patricia Kayden
Good to hear that some Repub governors are coming to their senses vis-a-vis Obamacare. See, it’s not really so tough to do something positive for your citizens after all.
WereBear
I have had The Conversation: a local broker flat out told me lies about Obamacare, and was firm in their conviction that since they thought giving people who “couldn’t afford it” health care, it would then make their taxes go up.
Dead people? Not their problem.
Enhanced Voting Techniques
“My fellow citizens of Kentucky, I have governor have successfully dismantled the wasteful and oppressive Obama care program mandated on us by Washington and implemented the Affordable Care Act to bring you the health care you deserve….”
HinTN
It’s going to be really embarrassing when The legislature of “The Great State of Tennessee” (TM) is more Ni-clang red than our brothers to the south.
raven
@BGinCHI: Wakes up, you are kidding?
raven
@BGinCHI: We head out in tomorrow to drive down through Troy, Elba, Jack and points south in Alabama.
Benw
And here we were making fun of KY Republican voters, but they got exactly what they wanted: keep their healthcare AND hoist a big old middle finger to gays, liberals, and the lazy usurper in the WH. Well done, indeed!
Ken
The Republican approach to government in a nutshell.
low-tech cyclist
Richard, what happens if Kentucky applies for a 1115 waiver and is turned down? Does the existing Medicaid expansion in Kentucky end, or stay in place as is, or what?
low-tech cyclist
@Ken:
Yep, if they can’t get away with dismantling a program, they’ll throw sand in the gears, and then rail about how government doesn’t work.
Richard Mayhew
@low-tech cyclist: Really good question… Kentucky is in an odd spot as there is a state law requiring that the Governor accept any Medicaid money that is made available to the state.
Shutting off expansion violates that law.
Most likely Bevins et al will submit an atrocious waiver. HHS will say no way, try again and look at what we have approved in Indiana, Montana, Pennsylvania etc for guidance on what we’re likely to approve on your resubmission.
What Have the Romans Ever Done for Us?
Once again conservatism fails to fail, it just is failed by those staunch proponents who fail it once elected. .
Mnemosyne (iPhone)
@Benw:
Yep — they were sure that Bevin wouldn’t leave them hanging, and he didn’t. The small amount of pain from paying higher premiums or copay isn’t as bad as losing the insurance altogether, so they get everything they wanted.
Mnemosyne (iPhone)
Also, too — I think it’s pretty obvious by now that Republicans have come to accept that they can’t actually reverse Obamacare, especially if they’re in states that accepted Medicaid expansion. All they can do is make it crappier. Therefore, Democrats need to come up with a strategy other than “they’re going to take your insurance away!” because we’ll look like liars. What should the new strategy be? Reducing costs? Better consumer protections? Increasing access?
KithKanan
@Richard Mayhew: Why should HHS approve ANY Medicare waiver? Kentucky has already expanded medicaid, and I fail to see how any program they come up with is liable to accomplish any of:
1) increase and strengthen overall coverage of low-income individuals in the state;
2) increase access to, stabilize, and strengthen providers and provider networks available to serve Medicaid and low-income populations in the state;
3) improve health outcomes for Medicaid and other low-income populations in the state; or
4) increase the efficiency and quality of care for Medicaid and other low-income populations through initiatives to transform service delivery networks.
relative to a traditional expansion. At this point approving a waiver is more or less paying them to make things worse than the status quo.
I don’t particularly feel that’s a good use of my tax money, so if I were making the decision I’d tell them to pound sand unless they actually had a proposal that was an improvement over traditional medicaid.
Richard Mayhew
Depends on the waiver. If it is tying Medicaid to work, go pound sand. If it is an isomorph of Indiana with Kentucky characteristics, then hhs is in shaky legal grounds if they deny as they have approved similar waivers so similar waivers meet the 1115 conditions
And if there is a flat no and begins can get the KY leg to change the law requiring acceptance of all Medicaid funds available (zandar what is that probability? ) then walking away is a credible threat.
low-tech cyclist
Richard, thanks for your replies here. That gives me a much better idea of what could happen in Kentucky.
And yeah, whether he can get the KY legislature to change the law requiring acceptance of all available Medicaid funds is really the big question. Gotta hope the answer is a big NO, but these days you never know. GOP voters will cut off their nose to spite their face, and toss in their ears (weren’t using them anyway, except to listen to talk radio!) as part of the deal.