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Gov. Mike Pence speaking at Tea Party rally.March 31, 2011
Gov. Mike Pence's old tea party buddies aren't going to like this.

Indiana's governor (and possible 2016 Republican contender) Mike Pence is taking a gamble, like Chris Christie did before him. Pence is going to try to expand Medicaid in Indiana, using an Arkansas-like private option. He's attaching enough strings—enrollees have to pay part of the premiums, some would have to set up health savings accounts, limits on emergency room care—that the federal government will have to take a very close look before granting the waiver Pence will need to move forward with it.

In true Republican fashion, when Pence announced the proposal, he said it was intended to "alleviate the coverage gap created by the Affordable Care Act." See, it was Obamacare that created the coverage gap, not his refusal to accept Medicaid expansion funds (or the U.S. Supreme Court) that left 350,000 Hoosiers out in the cold. At the same time, though, Pence is signaling that the serious Republican crowd (which does not include Bobby Jindal) is figuring out how to move on from repeal-and-only-repeal.

When a committed and high-profile Obamacare foe like Pence indicates he’s going to find a way to work within the new reality of the Affordable Care Act, he’s doing two things. First, he’s making the die-hard “repeal Obamacare” crowd look unreasonable. If Mike Pence can learn to live with the ACA, then anyone can. Second, he’s sending a message to Republican leaders in other states that it’s possible to take advantage of the law’s benefits while saving face as a small-government conservative. As the New York Times’ Aaron E. Carroll put it: “If Mr. Pence can find a way, it’s likely some of the 23 holdout states will eventually follow.” […]

But for conservatives who resent Pence for giving up the ghost, this is a problem.

Specifically, it’s a problem for Republicans who still hope to make the Affordable Care Act a deathly toxic issue for Democrats in 2014. Yes, the issue has receded lately as a streak of ACA victories sucked the wind out of the anti-Obamacare movement, but it will return in time for Election Day. If the feds give Pence the thumbs-up to go ahead with his expansion plan, Republican candidates fulminating against the law could find themselves asked to explain why they can’t tolerate Obamacare when the ultraconservative governor of Indiana found a way.

Candidates running against Pence might very well call into question Pence's status as an ultraconservative governor. But the closer we get to 2016—hell, the closer we get to November 2014—the harder it will be for conservatives to justify opposition to a law that's given millions of people access to affordable health insurance. It's the problem even they knew they'd have if the law was ever implemented—it would help people and then they wouldn't be able to take it away!

Pence is trying to work his way out of the trap Republicans set for themselves by staking so much politically on fighting Obamacare. His success could mean the end of the Republican Obamacare repeal fever dream.

Originally posted to Joan McCarter on Mon May 19, 2014 at 02:22 PM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (24+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Mon May 19, 2014 at 02:22:08 PM PDT

  •  Interesting, he was rather fringe in Congress (3+ / 0-)
    Recommended by:
    drmah, wishingwell, Pilotshark
    •  real people he meets need this and he can (1+ / 0-)
      Recommended by:
      a2nite

      actually help them all by himself....maybe Jesus whispered ...you can do the work you claim you want to do, my work....

      "The poor can never be made to suffer enough." Jimmy Breslin

      by merrywidow on Mon May 19, 2014 at 02:47:22 PM PDT

      [ Parent ]

      •  Not in the least (8+ / 0-)

        Pence is trying to be the sharpest hammer in the clown car with this, so as to keep his Presidential ambitions alive. He is simultaneously claiming in a dozen different ways that this is not the dreaded Obamacare while angling to take Federal money and to ding the poor and hospitals at every opportunity.

        Pence claims that Obamacare created the Medicaid gap, not the Governors who refused Medicaid expansion.

        The plan gives all of that lovely Federal money plus the Indiana cigarette tax revenue and an assessment on hospitals to insurance companies to provide policies for limited Medicaid coverage.

        The poor are required to contribute in several different ways to their own coverage, or else lose dental and eye care.

        The plan limits the number of Emergency Room visits.

        This plan is supposed to have a 30-day state review, and then HHS will decide whether it can be implemented.

        Back off, man. I'm a logician.—GOPBusters™

        by Mokurai on Mon May 19, 2014 at 05:46:25 PM PDT

        [ Parent ]

    •  It's the Richard Nixon Secret Vietnamese War Plan- (0+ / 0-)

      Declare victory, and then run away as fast as you can.

      Warren/Grayson 2016! Yes We Can!

      by BenFranklin99 on Wed May 21, 2014 at 02:25:18 AM PDT

      [ Parent ]

  •  In order to save this village we had to destroy it (2+ / 0-)
    Recommended by:
    Just Bob, Kingsmeg

    In order to expand Medicaid, we had to privatize it.  Now, with a second precedent in the offing, that's just what could happen in the not too distant future.

    "When dealing with terrorism, civil and human rights are not applicable." Egyptian military spokesman.

    by Paleo on Mon May 19, 2014 at 02:41:10 PM PDT

  •  Unless he can restrict it to Whites.... (7+ / 0-)

    ...I don't think he'll be able to pull this one off. The root cause of conservative hostility to social programs is that some of the money goes to people who aren't White.

    It's not the side effects of the cocaine/I'm thinking that it must be love

    by Rich in PA on Mon May 19, 2014 at 03:20:08 PM PDT

  •  This is Teabag insurance- (3+ / 0-)
    Recommended by:
    Just Bob, drmah, a2nite

    Everything is on the backs of the consumers. Check out what happens if a bill or premium isn't paid. It's designed so that the poorest aka the non whites won't be able to afford it.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Mon May 19, 2014 at 03:39:33 PM PDT

    •  Actually, it is not as bad as I feared (1+ / 0-)
      Recommended by:
      charliehall2

      Those who can pay nothing are restricted to the minimum level of coverage, but not actually cut off in this version, unlike the previous supposed Health Indiana Plan.

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Mon May 19, 2014 at 05:51:08 PM PDT

      [ Parent ]

  •  I heard from a source that the insurance industry (4+ / 0-)
    Recommended by:
    Mokurai, a2nite, ferg, FindingMyVoice

    in Indiana lobbied very hard for this. My wife use to work in Indiana for Golden Rule (now part of United Healthcare) so she has contact there. Indiana actually has a rather large amount of insurance companies and workers so I can image they pushed hard for this. Infact the medical accounts (HSA) were pionered by Golden rule and the former owner is a big Hoosier GOP donor, so I can image he was pushing this behind the scenes. Big money has always called the shots in the GOP, so I'm not surprised by this.

    -1.63/ -1.49 "Speaking truth to power" (with snark of course)! Follow on Twitter @dopper0189

    by dopper0189 on Mon May 19, 2014 at 04:24:35 PM PDT

  •  This has NOTHING to do with insurance. This is (4+ / 0-)

    Pence's way of saying he's a Republican hopeful for Presidential candidate in 2016.  He could give a rat's ass about people needing healthcare.

    •  same reason the constitutional ammendment (1+ / 0-)
      Recommended by:
      drmah

      to forever ban gay marriage in Indiana surprisingly came out of committee.  Once Chris Christie imploded, Pence thinks that he is the man.

      You should see his "mission accomplished" speech in front of the Lake County hospital with the MERs patient.  God he really thinks he is going somewhere.

      •  He's planning on running on "school improvement" (0+ / 0-)

        but with his leadership and that of former Republican Gov, Daniels, Indiana ranks 48th in test scores in the nation and at the very bottom in support of special needs children.

  •  Small government? (3+ / 0-)
    Recommended by:
    tampaedski, drmah, FindingMyVoice
    enrollees have to pay part of the premiums, some would have to set up health savings accounts, limits on emergency room care
    How is more rules = small government?

    Republican tax policies have led to financial conditions which have caused Republicans to demand cuts to programs they have always opposed.

    by AppleP on Tue May 20, 2014 at 07:45:16 AM PDT

  •  I like the idea of a limit to Emergency Room Visit (1+ / 0-)
    Recommended by:
    charliehall2

    Since our state did the medicaid expansion, we have had a spike in Emergency Department visits from Medicaid holders.  The state said this would happen, and it has.  Informal questions get the answer that calling 911 is easier and quicker than calling a doctor's office and getting an appointment in two days.

    I wish Metro Gov would do a "Whentocall911.com" campaign, or even the portable computer with a Doc on the other end to deny transport by ambulance for what is really stupid stuff - sunburned legs, tooth aches, low grade fever, intoxicated and can't walk, etc

    People with private insurance use the ambulance less because they pay more for it than medicaid insurance does.  

    Stupid question hour starts now and ends in five minutes.

    by DrillSgtK on Tue May 20, 2014 at 07:45:24 AM PDT

  •  NBA (1+ / 0-)
    Recommended by:
    drmah

    The 4 teams still in the playoffs are from Indiana, Florida, Oklahoma, and Texas---does the prove there's a correlation between bad government and good basketball?  From a political standpoint, which state is least bad?

    Actions speak louder than petitions.

    by melvynny on Tue May 20, 2014 at 07:45:40 AM PDT

  •  The ACA created the gap by pointing out (2+ / 0-)
    Recommended by:
    FindingMyVoice, Ellamenta

    how many people weren't covered.  Before the ACA, these people didn't exist.

    "Moon landing was real. Evolution exists. Tax cuts lose revenue. The research has shown this a thousand times. Enough already." - Austan Goolsbee

    by anonevent on Tue May 20, 2014 at 07:53:01 AM PDT

  •  I do enjoy... (4+ / 0-)

    the irony of a senior citizen holding a sign saying "extreme spending requires extreme cuts".

    Probably is one those (apparently great many) seniors that thinks Medicare has nothing to do with the government.

    "It's almost as if we're watching Mitt Romney on Safari in his own country." -- Jonathan Capeheart

    by JackND on Tue May 20, 2014 at 07:53:51 AM PDT

  •  ACA's stupid eligibility rules created the problem (0+ / 0-)

    They left people vulnerable. Frankly, the Supreme Court's ruling on Medicaid expansion was predictable -- It's pretty much the same thing they have said on EVERY SINGLE FREAKIN' state-federal partnership that has ever come down the line.

    If there were no lower income limit to elegibility on the exchanges, the gap wouldn't exist.  It is a problem even in states that implement the expanded Medicaid because some people simply do not want Medicaid.

    That was also part of the reason we couldn't get my daughter on our insurance.  She was required to demonstrate that she had been declined by Medicaid even though she, as a full-time student in a state that declined the Medicaid expansion clearly didn't qualify and we were willing to pay the full unsubsidized cost of putting her on our plan.

    Honestly, I'm impressed by the hero duty many people have pulled trying to get all of this stuff to work, but I suspect there remains a train-wreck struggling to get out.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Tue May 20, 2014 at 07:55:43 AM PDT

  •  All the qualifications (0+ / 0-)

    They are simply going to make it more expensive.  

    A.  Profit needs to come from somewhere.  

    B.  All those qualifications just add to the bureaucracy.  

    Seriously?  Limiting Emergency room visits?  

    how about you just deal with the tiny number of people that applies to?

    Streichholzschächtelchen

    by otto on Tue May 20, 2014 at 09:25:49 AM PDT

  •  many conservative relatives (0+ / 0-)

    are claiming NOW they have no insurance, BECAUSE of Obamacare.  Most have had hours cut, one was dropped from his wife's because there are less than 50 employees and he's disabled.  I didn't know how to answer that last one.  Surely that's not how the law is supposed to work.

    I'm a Kennedy Catholic.

    by EquiStar on Tue May 20, 2014 at 10:02:18 AM PDT

    •  Dropped From Wife's Coverage (1+ / 0-)
      Recommended by:
      EquiStar

      I don't see how dropping coverage for dependents could have been caused by Obamacare.  The fact that preexisting conditions cannot be a bar to coverage might mean that the employer feels no compunction about changing the terms of the coverage offered to employees, but that is not the fault of the Affordable Care Act.  It is just an excuse being offered, disingenuously. Similarly, cutting hours is likely something that was going to happen anyway, and Obamacare is being offered as an excuse.  

  •  Don't think the feds should give him (0+ / 0-)

    such a waver...that'll be a pretty bad precedent...

    He's attaching enough strings—enrollees have to pay part of the premiums, some would have to set up health savings accounts, limits on emergency room care

    "When fascism comes to America, it will be wrapped in a flag and carrying a cross." Sinclair Lewis, 1935 --Talk of foresight--

    by tuma on Tue May 20, 2014 at 10:31:18 AM PDT

  •  Nuanced approach … (1+ / 0-)
    Recommended by:
    BenFranklin99

    never works for the Guns Over People party.

    Americans are in real trouble. The oligarchs are misanthropes.

    by Road to1 Escondido on Tue May 20, 2014 at 11:12:11 AM PDT

  •  The requested waivers may be ok (1+ / 0-)
    Recommended by:
    BenFranklin99

    if the proposed premiums are sufficiently low. Medicaid in most states is junk insurance and private plans are often better. And getting people to go to clinics or urgent care centers rather than emergency rooms for non-life-threatening conditions is a good idea. The devil of course will be in the details.

  •  Pence Proposal to to coExpand Medicaid (1+ / 0-)
    Recommended by:
    BenFranklin99

    Because he wants to "alleviate the coverage gap created by the Affordable Care Act"
    --the only apt description is chutzpah
    --and dishonesty
    --and hypocrisy.
    Oh wait, he's a Republican--'nuff said.

  •  We need a non-profit alternative (0+ / 0-)

    If business is as efficient as Republicans claim, business can treat disease and injuries for less, than government health care, like British National Health, can.  If competition and the invisible hand of the marketplace is so good, then let's have a one on one competition.  May the best system win.  Republicans will never permit such a competition, because they are liars and hypocrites who in fact favor business, no matter which system is more efficient.

    Warren/Grayson 2016! Yes We Can!

    by BenFranklin99 on Wed May 21, 2014 at 03:21:44 AM PDT

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