The politics of Medicaid expansion tricky for Republicans | Arkansas Blog

Monday, November 18, 2013

The politics of Medicaid expansion tricky for Republicans

Posted By on Mon, Nov 18, 2013 at 11:31 AM

Interesting news from Louisiana, where on Saturday political newcomer Vance McAllister toppled state Sen. Neil Riser in an all-Republican runoff for the state's vacant 5th Congressional District seat. McAllister came out in support of Medicaid expansion, which has been rejected thus far by Louisiana Governor Bobby Jindal, prompting Riser to argue that "a vote for Vance McAllister is a vote for Obamacare." Apparently, this time, Obamacare won. 

The politics of Medicaid expansion have always been complicated. On the one hand, expansion is part of the Affordable Care Act, and opposition to Obamacare has become the core litmus test of the Republican party. On the other hand, the way the law is structured, expansion is an extremely good fiscal deal for states and many powerful local interests — particularly hospitals — have a lot to gain (not to mention the real human stakes: the millions of low-income uninsured with a chance to gain coverage). 

These considerations explain why we've seen many Republican governors come out in support of expansion even though they oppose Obamacare. Of course in Arkansas, the state pursued its own unique version of expansion, the "private option," an effort led by Republican lawmakers which continues to divide the party. 

Perhaps the off-year elections in Virginia and New Jersey give some hints, but it's far too early to know whether positioning on Medicaid expansion will have electoral consequences. But, as the Times-Picayune's story on Saturday's race in Louisiana makes clear, the political question is more complicated than "Obamacare bad." 

While some thought the all-Republican runoff would be marked by each candidate running to the far right of every issue, McAllister took leave of the usual party line during a debate last week by coming out in support of optional Medicaid expansion offered under the Affordable Care Act.

McAllister said he disagreed with Gov. Bobby Jindal's decision not to accept the expansion because of the economic make-up of the 5th District.

According to census data, the district is one of the poorest in the nation with nearly 25 percent of its more than 750,000 people living below the poverty line in 2010 and 21 percent without health insurance.

Riser blasted McAllister for the admission, issuing an ad stating "a vote for Vance McAllister is a vote for Obamacare." 

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