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.” […]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!
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.
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.