Health Care Reform Forces Republican Governors to Walk Fine Line
Their apparent struggles on the issue, along with other postures by their GOP colleagues elsewhere, suggest political uncertainty for Republicans as the Affordable Care Act starts to go into effect two years after clearing Congress without a single Republican vote. The risks also are acute for governors in Democratic-leaning or swing-voting states or who know their records will be parsed should they seek the presidency in 2016 or beyond.
Indeed, cracks keep growing in the near-unanimous Republican rejection of Obama's health care law that characterized the GOP's political messaging for the last two years. Five GOP-led states — Idaho, Mississippi, Nevada, New Mexico, and Utah — are pressing ahead with state insurance exchanges. Ongoing monitoring by The Associated Press shows that another five Republican-led states are pursuing or seriously a partnership with Washington to help run the new markets."It's a tough call for many Republican governors who want to do the best thing for their state but don't want to be seen as advancing an overhaul that many Republicans continue to detest," said Whit Ayers, a consultant in Virginia whose clients include Gov. Bill Haslam of Tennessee, a Republican who didn't announce his rejection of a state exchange until days before Sebelius's Dec. 14 deadline.
Democrats, meanwhile, hope to use the law and Republican inflexibility to their advantage, betting that more Americans will embrace the law once it expands coverage. The calculus for voters, Democrats assume, will become more about the policy and less about a polarizing president.
"It shouldn't be complicated at all," said John Anzalone, an Obama pollster who assists Democrats in federal races across the country. Anzalone said Republicans could use their own states-rights argument to justify running exchanges. Instead, he said, "They are blinded by Obama-hatred rather than seeing what's good for their citizens."
National exit polls from last month's election showed that 49 percent of voters wanted some or all of Obama's signature legislative achievement rolled back. Among self-identified independents, that number was 58 percent. Among Republicans, it spiked to 81 percent. When asked about the role of government, half of respondents said the notion that government is doing too much fits their views more closely than the idea that government should do more.
Before the election, a national AP-GfK poll suggested that 63 percent of respondents preferred their states to run insurance exchanges, almost double the 32 percent who wanted the federal government to take that role. And the same electorate that tilts toward repealing some or all of the new law clearly re-elected its champion.
That's not the most important consideration for governors who face re-election in Republican states. Georgia's Nathan Deal and Alabama's Robert Bentley, who also face 2014 campaigns, initially set up advisory commissions to consider how to carry out the health care law, but they've since jumped ship. But, unlike others, Deal and Bentley aren't eyeing national office.
Deal, the Georgia governor, offers the typical argument for saying no: "We can't afford it." But the law envisions the new Medicaid coverage more or less as a replacement of an existing financing situation that pays hospitals to treat the uninsured. The law contemplates cuts in that program, which already requires state seed money. The idea was that expanding Medicaid coverage would reduce "uncompensated care" costs.
"Some of those cuts were made with the expectation that Medicaid would be expanded and that hospitals would be paid for portions of business that we are not being paid for now," said Don Dalton of the North Carolina Hospital Association.