The New York Times has a
thoughtful article on the "complicated politics of Medicaid expansion."
In Pennsylvania, Gov. Tom Wolf, a newly elected Democrat, is scrapping his Republican predecessor’s conservative approach to expanding Medicaid under the Affordable Care Act. Mr. Wolf said this week that he would instead pursue a straightforward expansion of the government health insurance program for the poor, no longer charging premiums or limiting benefits for some enrollees.
In Tennessee and Wyoming, however, bills to extend Medicaid to far more low-income residents under the law were quashed by Republican legislators last week, despite having the support of the states’ Republican governors. Opponents in both states said that, among other things, they did not believe the federal government would keep its promise of paying at least 90 percent of the cost of expanding the program. It currently pays the full cost, but the law reduces the federal share to 90 percent—a permanent obligation, it says—by 2020.
Medicaid expansion is getting another look in many conservative states this year—Tennessee, Wyoming, Utah, Montana, Idaho—though appears dead in the first two. And here where's this issue might just not be so complicated, at least not for Republicans.
Tennessee’s chapter of Americans for Prosperity, the Tea Party-affiliated group backed by Charles G. and David H. Koch, and the Beacon Center of Tennessee, a Nashville nonprofit that advocates smaller government, urged the Legislature to scuttle the governor’s plan.
The Kochs didn't just "urge" Tennessee lawmakers, they
campaigned against them and a Koch-affiliated group did the same in
Wyoming. The Kochs are also threatening
Montana legislators over the issue, though with less success.
There's nothing complicated about the money Kochs and others are spending to target Republican lawmakers who are even thinking about maybe considering helping out their constituents and their states. It's a litmus test, plain and simple. At the heart of it is really an existential battle for the Republican party, one that the Kochs are so far winning.