One of the oddest political turnarounds in recent days has been the emergence of Governor Jan Brewer of Arizona as an Obamacare hero. Up until now, Brewer was known primarily for her forceful advocacy of the notorious anti-immigrant measure S.B. 1070, for supposedly wagging her finger at the president of the United States on an airport tarmac, for claiming weirdly that headless bodies were showing up in the Arizona desert, and for perhaps the most epic brain freeze in the history of televised debates. Yet despite being a fervent opponent of the Affordable Care Act, Brewer not only decided to accept the expansion of Medicaid that is being rejected by many of her fellow GOP governors, she campaigned aggressively for it over the objection of many Arizona Republicans, and yesterday she won the battle when the expansion passed the Arizona Legislature.
So will other Republican governors follow her lead? Perhaps, but it's going to depend a lot on their own personal political calendars.
Let's just get this out of the way to start: Turning down the Medicaid expansion isn't just fiscally stupid, it's morally vile, no matter what you may think of government health insurance. A recent RAND Corporation study showed what people like me have been saying all along, that when states turn down the federal funding for the Medicaid expansion, not only will they miss out on the money, they'll be spending more money of their own on uncompensated care and leaving huge numbers of their citizens without insurance. It's particularly despicable in the states in question, since as Republican-led states they've already set the eligibility levels for Medicaid absurdly low. In a state like Texas or Arizona, if you're not living in a van down by the river, the state probably considers you too wealthy to get Medicaid.
To return to the calendar issue, perhaps the most important thing to understand about Brewer is this: She won't be running for re-election in 2014, because Arizona governors are limited to eight consecutive years in office. Brewer took office in 2009 when Janet Napolitano became secretary of Homeland Security, then won a full term in 2010, so she can't run for another term when this one is up. So she has at least some ability to look at this issue rationally, without worrying about getting a primary challenge from the right. And she quite reasonably decided that even though she doesn't like Obamacare, it would be idiotic to turn down a bunch of money from the federal government that will provide health insurance for the poorest citizens in Arizona, relieving the state of the burden of paying for their care when they show up in the emergency room and improving their health and productivity to boot.
There are some governors, like, say, Rick Perry, whose hearts are so twisted and cruel that they would rather see a poor person go without health insurance than see them get Medicaid, even if the federal government is picking up the tab. But for a bunch of others, the political stars can come into the right alignment and push them toward the Medicaid expansion. Rick Scott in Florida, for instance, is up for re-election next year too, but he's an unpopular governor in a swing state, so it's good politics for him to show that despite all appearances, he's not actually a Bond villain who would toss your puppy into a pool full of alligators if he had the chance. He probably has more to fear from a Democrat in a general election than from other Republicans in a primary, which made it possible for him to support Medicaid expansion.
I haven't gone state-by-state through all the other Republican governors refusing to expand Medicaid. But over the next few years, there may be some who follow Brewer's lead, as the benefits just become too overwhelming to ignore. When that happens though, you can bet it was only where they didn't have an election coming up or they weren't afraid of their right flank, not because they just decided to do the right thing.
