Obamacare and GOP Governors – Is This a Tipping Point?

Gov. John Kasich's choice to expand Ohio's Medicaid program may provide political cover to other Republicans who have vehemently opposed the Affordable Care Act.

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Joshua A. Bickel / Corbis

Ohio Gov. John Kasich addresses the crowd during a campaign rally with presidential candidate Mitt Romney at Port Columbus International Airport in Columbus, on Nov. 5, 2012.

This post was updated at 2:20 p.m. on Feb. 6, 2013

Opposing the Affordable Care Act appears to have gone from a principled stance to an impracticality for some Republican governors. In a move drawing fierce criticism from some conservatives, Ohio Gov. John Kasich (who campaigned in 2010 on a platform that included denouncing the health care law) announced on Monday that he supports a vast expansion of his state’s Medicaid program, made possible by the ACA, that could bring new insurance coverage to millions of Americans nationwide. Then Wednesday, Michigan’s governor, Republican Rick Snyder, followed suit. In total, six Republican governors have now said they will participate in Obamacare’s Medicare expansion.

Because he had been so critical of the ACA in the past, Kasich’s decision could provide political cover for other Republican governors who may be considering similar expansions of Medicaid, which is a joint state and federal program. Under the ACA, states that open Medicaid to everyone earning up to 133% of the federal poverty level ($14,856 in 2012 for a single person) will receive 100% federal funding for newly eligible enrollees initially, phasing down to 90% by 2020. (Most states now receive a far smaller federal match for Medicaid beneficiaries.) Kasich said it “makes great sense for the state of Ohio.”

Still, Kasich’s decision, presented as part of his latest budget that now goes before the state legislature, was surprising. He joined more than 20 other states that sued to overturn the ACA back in 2011. After the U.S. Supreme Court upheld the constitutionality of the health care law but said the Medicaid expansion specifically should be optional for states, Kasich issued a statement saying that he was “very concerned that a sudden, dramatic increase in Medicaid spending could threaten Ohio’s ability to pursue needed reforms in other areas, such as education.”

Philip Klein, a conservative writer for the Washington Examiner, says Kasich’s Medicaid decision is “political cowardice” and “a demonstration of how difficult it is to defeat big government.” An editorial in the Wall Street Journal titled “The GOP’s ObamaCare Flippers” accused Kasich and the other GOP governors of accepting a federal “bribe” by signing up to take the generous federal matching funds for expanding Medicaid. The Ohio affiliate of the conservative group Media Trackers said Kasich’s Medicaid cave “means a total collapse in Kasich’s credibility on Washington spending.”

Some Republican governors have said they won’t expand Medicaid, while others are still undecided. On Tuesday, Pennsylvania’s Republican Gov. Tom Corbett said he opposes an expansion of Medidcaid in his state. There is no deadline to sign up for the program, but governors across the country have been under tremendous financial pressure from health care providers in their states who would benefit from enlarging Medicaid. Hospitals now provide charity care to residents who would qualify for Medicaid if it were expanded to ACA levels. Under the law, the federal reimbursements these hospitals now get for providing the free care will gradually decrease, leaving these facilities in the lurch without new Medicaid-covered patients to make up the difference.