House Speaker Paul Ryan was foiled last week in his attempt to destroy Medicaid to get money for tax cuts to the wealthy when Trumpcare was pulled off the House floor. It doesn't mean he won't try again, but next time is going to be even harder. One reason is smack dab in the middle of the actual, and symbolic, heartland: the Kansas legislature has voted to expand Medicaid under the Affordable Care Act.
Gov. Sam Brownback must now decide whether to sign or veto Medicaid expansion after the Senate passed the bill Tuesday.
The Senate gave final approval to expansion in a 25-14 vote Tuesday. The House approved the legislation earlier.
Brownback and his aides have been critical of expansion. Spokeswoman Melika Willoughby said Monday that the Affordable Care Act is in a "death spiral" and that expanding Medicaid eligibility would not be responsible policy. […]
Supporters hope that Brownback will change his mind on expansion or that they can come up with enough votes to overcome a veto.
To override a veto, supporters need 84 votes in the House and 27 votes in the Senate. Bollier said she knows of one no vote that could flip to yes in the Senate, and added if there’s one vote, there might be two – enough for an override in the Senate.
The House approved the bill 81-44, and would need three more votes to override.
Obamacare is clearly not in death spiral but Trumpcare—with Ryan's destruction of Medicaid—is. The fact is that Medicaid lives on, and was a huge part of what helped to defeat Trumpcare within the Republican conference. Republicans from expansion states were steadfastly opposed to the Medicaid cuts, as were Republican governors. And it wasn't just the moderates.
"Even some conservatives — Christopher H. Smith of New Jersey, for example, and Daniel Webster of Florida — expressed concerns about the number of Medicaid recipients who could suffer."
That's because Medicaid is so critical to the nation's healthcare system as a whole—not just Obamacare, but the whole system. One in five Americans—74 million—depend on the program, stretching from the beginning of life to the end of it. It's providing drug treatment to people caught up in the opioid epidemic. It's providing healthcare to children and keeping elderly people in care facilities. It's one of the reasons why the program has such strong public support—three-quarters of the population has had some kind of personal experience with it.
It's a reflection of Paul Ryan's misunderstanding of the realties of the society in which he lives, or maybe just the degree of his sociopathy, that he remains so intent on taking it away. If Kansas does this, if it persists and takes the expansion, it really will be Ryan against the world.