Why are Republican state officials so against Medicaid expansion?

[I spent the winter writing songs about getting better]

As John Kasich pointed out, expanding Medicaid is hardly "supporting Obamacare" because the Feds are paying for it. They will subsidize the states the entirety of it until 2019 and almost all of it later. For the time being, there is zero benefit to not taking the money. People like Mark Bevin are making a big fuss on that they are booting people off Medicaid and not saving the state a dime...actually probably costing the state money since now those people if they end up with serious conditions will still have to be treated at public hospitals but they won't be able to pay for it.

There's literally zero benefit regardless of your position on Obamacare. I don't get it.

[Mr. Reactionary]

Medicaid is expensive and 49 States have balanced budget requirements. Yeah, the Feds paying for 90% of an expansion may seem like a great deal at first, but States will still eventually have to cover that 10%. And 10% can pretty big when reduced to an actual number.

[Landslide Lyndon]

Because they view anyone covered by Medicaid as a moocher and a taker who deserves to suffer as a punishment for being lazy.

[Likely Voter]

Medicaid is expensive and 49 States have balanced budget requirements. Yeah, the Feds paying for 90% of an expansion may seem like a great deal at first, but States will still eventually have to cover that 10%. And 10% can pretty big when reduced to an actual number.

But that 90% will flow into the state, paying people and business who pay state income and sales taxes. Plus it will cover a lot of sick people who would otherwise go to emergency rooms anyway.

Ignoring the morality of how it helps the working poor, taking the money makes sense financially, which is why some 'red states' are doing it. The reason not to is purely ideological and I suspect that after Obama is gone the 20 states that have refused the money will slowly but surely find ways to take it. Especially as it becomes clear that Obamacare is not going to go away, even if a GOPer is elected President.

[Okay, maybe Mike Johnson is a competent parliamentarian.]

Medicaid is expensive and 49 States have balanced budget requirements. Yeah, the Feds paying for 90% of an expansion may seem like a great deal at first, but States will still eventually have to cover that 10%. And 10% can pretty big when reduced to an actual number.

But that 90% will flow into the state, paying people and business who pay state income and sales taxes. Plus it will cover a lot of sick people who would otherwise go to emergency rooms anyway.

Ignoring the morality of how it helps the working poor, taking the money makes sense financially, which is why some 'red states' are doing it. The reason not to is purely ideological and I suspect that after Obama is gone the 20 states that have refused the money will slowly but surely find ways to take it. Especially as it becomes clear that Obamacare is not going to go away, even if a GOPer is elected President.

We could debate long and hard about the morality of Medicaid.

I'm sure we could.

[Vosem]

Ideological reasons, basically. The idea that, while not taking the money may certainly harm the state in the short run, in the long run it will help the nation by overthrowing Obamacare.

[Joe Republic]

Medicaid is expensive and 49 States have balanced budget requirements. Yeah, the Feds paying for 90% of an expansion may seem like a great deal at first, but States will still eventually have to cover that 10%. And 10% can pretty big when reduced to an actual number.

But that 90% will flow into the state, paying people and business who pay state income and sales taxes. Plus it will cover a lot of sick people who would otherwise go to emergency rooms anyway.

Ignoring the morality of how it helps the working poor, taking the money makes sense financially, which is why some 'red states' are doing it. The reason not to is purely ideological and I suspect that after Obama is gone the 20 states that have refused the money will slowly but surely find ways to take it. Especially as it becomes clear that Obamacare is not going to go away, even if a GOPer is elected President.

We could debate long and hard about the morality of Medicaid.

Sigh.  With most Republicans these days, that's very true.

[Zioneer]

It's an Obama policy and would kill their political dreams if they expanded it. That's basically the main reason, if Romney was in office and did the same thing, they would expand it Day 1.

[Famous Mortimer]

The Republican logic is quite obvious, heartless but obvious. They don't like taxes. That's the root of all their policies. Even if the federal government is paying, that still means people are paying increased federal taxes. Republicans think it's more important a billionaire not lose $5 than it is that a poor person be able to afford cancer treatment. Because the rich person doesn't get a choice whether to pay his taxes or not but the poor person has the hypothetical right to choose to pay for medical care (even though he can't in reality). That is the root of all ideological disagreement in US politics. Have you not been paying attention?

[pbrower2a]

Ideological reasons, basically. The idea that, while not taking the money may certainly harm the state in the short run, in the long run it will help the nation by overthrowing Obamacare.

The dichotomy between the nation and the people, especially poor people within it.

The real solution is to constrain the costs of medicine, mostly by ridding it of the monopolistic characteristics. Americans have the highest-cost medical care in the world, and that high-cost care gets unspectacular results. It also prices people into early and pointless deaths.   

[Clarko95 📚💰📈]

It's an Obama policy

[/thread]

[Badger]

Medicaid is expensive and 49 States have balanced budget requirements. Yeah, the Feds paying for 90% of an expansion may seem like a great deal at first, but States will still eventually have to cover that 10%. And 10% can pretty big when reduced to an actual number.

But that 90% will flow into the state, paying people and business who pay state income and sales taxes. Plus it will cover a lot of sick people who would otherwise go to emergency rooms anyway.

Ignoring the morality of how it helps the working poor, taking the money makes sense financially, which is why some 'red states' are doing it. The reason not to is purely ideological and I suspect that after Obama is gone the 20 states that have refused the money will slowly but surely find ways to take it. Especially as it becomes clear that Obamacare is not going to go away, even if a GOPer is elected President.

We could debate long and hard about the morality of Medicaid.

How? seriously, how? One can argue efficiency, cost containment, alternatives, and reforms, but how does one argue the basic morality of a system for caring for the ill?

Oh wait, you're a Paultard, and by Ayn Randian "logic" it is the highest moral affrontery in life for those too poor to afford medical care to greedily leach off of life's natural winners.

[Taco Truck 🚚]

I've even read serious articles arguing that emergency rooms should be allowed to turn away anyone who can't pay.

With a name like "Skill and Chance" you should appreciate the logic of such a proposal.  Really you need a healthcare system where ERs can turn away people because of lack of funds or a fully socialized system.  Those are the only two efficient systems out there.  What we have is neither... but it is a sick joke.

[The_Doctor]

Because the 10% in nature that would need to be paid can be considerable. I read a statistic noting that by 2017, Kentucky would need to pay $363 million from its budget. For a lot of states, the amount needed to pay would put a strain on the budget.

With an aging population and increasing health complications coupled with the budgetary restrictions most states face, the expansion is a legitimate issue to debate and resist.

[King]

We could debate long and hard about the morality of Medicaid.

I'm guessing we could debate long and hard about the morality of the fictional program that you think Medicaid is.  But the real program is air tight morally.

[TheDeadFlagBlues]

You must be logged in to read this quote.

http://www.democracycorps.com/Republican-Party-Project/inside-the-gop-report-on-focus-groups-with-evangelical-tea-party-and-moderate-republicans/

This goes beyond political or moral philosophy; the Republican base earnestly believes that the Affordable Care Act is an insidious scheme that's the first step towards totalitarianism. Whether or not Republican politicians actually believe this is besides the point: they're closely involved with circles in which they encounter these views and they're well-aware that "capitulating" will be punished with a costly primary challenge or a legislative revolt etc.

There's nothing about the beliefs/behavior of the average Republican voters that makes any amount of sense until it's realized that they:
1. believe that most or all Democratic politicians are crafty communist radicals who are using "moderate" rhetoric to induce dumb racial minorities to support what they view is a road towards a one-party state.
2. that they think that most "liberals" are brainwashed
3. that they actually tend to respect FDR or Truman or Kennedy and don't view all social programs in this light but rather, ones that benefit racial minorities.

This is why Republican primary voters have gravitated towards Ben Carson in a big way. To the average forumite, this is incomprehensible as most Republicans who post here are not in the orbit of Fox News or conservative talk radio, but his rhetoric is perfectly in line with what real conservatives feel, which could be characterized as racist lunacy. For these paranoid Evangelicals and Tea Party types, immigrants and African-Americans are merely dumb herd animals controlled by future authoritarian Democrats, who will surely seek to oppress white people by using Mexican immigrants or poor Blacks as foot soldiers.

I'm not exaggerating, focus groups are fairly clearly on this and I've found in my limited interactions with Evangelicals that this is a real concern. In the aftermath of Obama's re-election, a plummer at my local community bank noticed by Obama bumper sticker and was baffled; he earnestly wanted to know why I supported President Obama and I tried to respond in a candid manner. When I mentioned that I only knew a handful of people my age who supported Romney, he was really dismayed; not in the manner that ardent leftists were when W was re-elected but rather in a manner that evinced the fact that he thought that Obama was an authoritarian. I've had similar interactions, all with Evangelical Christians. Unsurprisingly, they're frightened by a society that has so quickly embraced casual sex, LGBT acceptance, non-marital cohabitation etc. When this dismay is combined with racism, it creates for a truly toxic reaction to Obama's America; these people actually feel that they're on the verge of being oppressed.

This is a venerable tradition of American movement conservatism so it's not surprising that it has moved to the forefront of political life again. See: Richard Hofstader's classic piece on The Paranoid Style in American Politics, written in 1964. It is pretty ironic that this paranoia is tied with a gullible sensibility that responds favorably to Nigerian princes, chain emails, goldbugs and Snake oil salesman.

[DS0816]

It's an Obama policy and would kill their political dreams if they expanded it. That's basically the main reason, if Romney was in office and did the same thing, they would expand it Day 1.

^ W I N N E R !

[bedstuy]

Because the 10% in nature that would need to be paid can be considerable. I read a statistic noting that by 2017, Kentucky would need to pay $363 million from its budget. For a lot of states, the amount needed to pay would put a strain on the budget.

With an aging population and increasing health complications coupled with the budgetary restrictions most states face, the expansion is a legitimate issue to debate and resist.

The Medicaid expansion wouldn't cost any state.  Whatever the up to 10% share, they are getting 100% of the benefits.  State and local governments pay to provide uncompensated care to uninsured people in hospitals.  The reduction in those costs will pay for the 10% share of the Medicaid expansion easily.

[7,052,770]

One common claim is that "we cannot trust the Federal Government to give us 90% forever. At some point, they will lower that amount and force the states to pay for the rest."

They also fear (probably unfounded, but in some cases founded) primary losses if they legitimize Obamacare in the eyes of the Far Right.

[The_Doctor]

Because the 10% in nature that would need to be paid can be considerable. I read a statistic noting that by 2017, Kentucky would need to pay $363 million from its budget. For a lot of states, the amount needed to pay would put a strain on the budget.

With an aging population and increasing health complications coupled with the budgetary restrictions most states face, the expansion is a legitimate issue to debate and resist.

The Medicaid expansion wouldn't cost any state.  Whatever the up to 10% share, they are getting 100% of the benefits.  State and local governments pay to provide uncompensated care to uninsured people in hospitals.  The reduction in those costs will pay for the 10% share of the Medicaid expansion easily.

I would have to see this actually playing out to believe the budget math. I don't think it's unreasonable to think that the states would have to pay more than they would otherwise. But I'll look into how much the states are paying in ER costs versus how much they would pay under expanded Medicare. It's an interesting policy question. If you are in fact right, then I would concede Medicare expansion would make sense for the states (while being a poor choice for the federal government; the budget deficits and rising interest rates make the idea difficult to finance on the federal level).

I'll update when I math this.

[Attorney General, LGC Speaker, and Former PPT Dwarven Dragon]

Because taking the money is effectively saying that parts of Obamacare are okay - and the Republican position is that the whole law is terrible. Yeah, they might bring back a few of the least controversial provisions in an eventual replacement bill, but they will start by gutting the whole entire law.

Furthermore, you believe that this medicaid expansion will no longer be an option - i.e. it will not exist - in 2017 (due to a republican being elected), then there is no reason to take it, as you'll have to fund it all yourself soon enough anyways, unless your state is mired in debt and needs temporary 'bill-paying help'.

And yeah, I believe that ObamaCare will be (effectively) repealed under a republican administration. If a republican is elected president, the Senate and House will obviously stay Republican as well. They might have the senate/house leaders abolish filibusters long enough to pass a repeal bill, or they might manage to scramble together enough democratic votes to effectively gut the law by repealing the individual and employer mandates, medicaid expansion, and some of the insurance policy requirements - i.e. the law (and perhaps the healthcare.gov website) will still exist in a technical sense but its most controversial provisions will be gone and the law will have far less impact than it was intended to. I think they may try for the latter option first, but if it doesn't work, they will certainly do the former. This law was one of Romney's biggest points about why Obama was bad in 2012, so it would be a true surprise if the Republicans didn't make its repeal essential should they win in 2016.

[muon2]

Because the 10% in nature that would need to be paid can be considerable. I read a statistic noting that by 2017, Kentucky would need to pay $363 million from its budget. For a lot of states, the amount needed to pay would put a strain on the budget.

With an aging population and increasing health complications coupled with the budgetary restrictions most states face, the expansion is a legitimate issue to debate and resist.

The Medicaid expansion wouldn't cost any state.  Whatever the up to 10% share, they are getting 100% of the benefits.  State and local governments pay to provide uncompensated care to uninsured people in hospitals.  The reduction in those costs will pay for the 10% share of the Medicaid expansion easily.

Actually Medicaid expansion turns out to be quite expensive for states because of the mandate, not the expansion itself. Advertising Medicaid expansion has the effect of advertising the mandate for all to enroll. This gets people who were previously eligible for old Medicaid but chose not to enroll in the system. The ACA says that these new enrollees are paid for under the old formula and the state pays 50%.

BTW I think DeadFlagBlues post and link is worth a read. He is describing the sentiment of real base Pub voters.

[Badger]

Medicaid is expensive and 49 States have balanced budget requirements. Yeah, the Feds paying for 90% of an expansion may seem like a great deal at first, but States will still eventually have to cover that 10%. And 10% can pretty big when reduced to an actual number.

But that 90% will flow into the state, paying people and business who pay state income and sales taxes. Plus it will cover a lot of sick people who would otherwise go to emergency rooms anyway.

Ignoring the morality of how it helps the working poor, taking the money makes sense financially, which is why some 'red states' are doing it. The reason not to is purely ideological and I suspect that after Obama is gone the 20 states that have refused the money will slowly but surely find ways to take it. Especially as it becomes clear that Obamacare is not going to go away, even if a GOPer is elected President.

We could debate long and hard about the morality of Medicaid.

How? seriously, how? One can argue efficiency, cost containment, alternatives, and reforms, but how does one argue the basic morality of a system for caring for the ill?

Oh wait, you're a Paultard, and by Ayn Randian "logic" it is the highest moral affrontery in life for those too poor to afford medical care to greedily leach off of life's natural winners.

Personal attacks by a liberal republican. Boy do I love it

1) NOT liberal
2) other than perhaps "paultard" (which i stand by fwiw), there was nothing "personal" whatsoever about my critique
3) your lack of a coherent response is telling.

[The_Doctor]

After reviewing the literature, I'm still not quite sure about the answer here. On one side, the costs of the expansion will definitely be incurred by the states if they expanded Medicaid. Many states are under a balanced budget requirement, which means they must balance their books no matter what. That makes an expansion harder on the states, because if more people sign up, costs go up for them. I'm not clear that preventive care and dwindling ER costs would make up for this; that's not proven by any measure, unless someone can prove it.

On balance, I oppose the expansion because I don't think with deficits being what they are (set to expand in the later half of this decade and next decade) that we can afford to take on such a major new expansion of entitlement spending. My argument on the expansion centers on the federal expansion more than the states (while leaving open the argument that the states don't appear to be saving money on balance from the expansion).

[Famous Mortimer]

Republicans think balancing the budget is more important than people having affordable healthcare.