This year is going to be a test for tea party Republicans of just how willing they are to reject Obamacare and everything associated with it—including taking health care away from hundreds of thousands of low-income residents of their states. There's increasing talk in a few of the red states that took the Medicaid expansion under the law to take it away, and in other states that seemed ready to topple, Republican legislative gains are
putting it in doubt.
Arizona and Arkansas, for instance, seemed like the top trophies in the expansion push. But the governors who embraced that part of Obamacare are gone, and hundreds of thousands of people could be stripped of their coverage if their successors don’t show the same zeal to defend it.
And the handful of Republican governors who are eyeing some form of expansion face roadblocks. For instance, Mike Pence of Indiana, a potential 2016 presidential contender, is attaching conservative policy elements unacceptable to the Obama administration. His potential 2016 rival John Kasich did expand Medicaid in Ohio but now must whip Republican support to keep it going. The governors of Tennessee, Utah and Wyoming all released proposals, as promised, after the elections. But so far in the two Western states, legislators are balking at taking on any part of Obamacare, even if the feds pick up the tab.
Arizona's Gov. Jan Brewer twisted arms and worked very hard to get the expansion, enraging many Republican legislators who responded with lawsuits. Now she's gone and her replacement, Republican Doug Ducey, hasn't said whether he'll give in to the tea party or fight to protect the program. The hurdle in Arkansas for its private option Medicaid seems insurmountable. Like Ducy, the new governor Asa Hutchinson has yet to weigh in. He's expected to do so in a couple of weeks, but the program needs three-fourths majorities in both chambers of the legislature to survive. In Ohio, Kasich used executive authority to take the expansion, but the program has to be renewed now by the legislature and the new House speaker, Republican Cliff Rosenberger, is a staunch opponent. In all three of these states, just keeping the program is going to be a heavy lift.
Some states are still in talks with the federal government over how to implement the program. Pence, in Indiana, is cynically offering a plan to appease some moderates, but making it so harsh the feds are unlikely to accept it, thereby keeping the extremists happy. Utah's Gary Herbert, in contrast, seems to genuinely want to figure out how to take the expansion. His challenge is to craft a program that has any chance of getting a very hostile legislature to approve, but isn't too extreme for the feds to agree to.
Caught in the middle are hundreds of thousands of people. Arkansas has had the biggest success in the country in reducing its uninsured rate because of its expansion, with more than 213,000 people now enrolled. There are about 250,000 enrolled in Arizona. So here's the real test of tea party ideology: are they so committed to killing Obamacare that these state Republicans will take their coverage away?