AP Photo/Harry Hamburg
Since the Tea Party emerged following President Barack Obama's victory in 2008, Republican governors have frequently been the faces of some of the most extreme policies in recent political memory. Even before her infamous "finger point" at the president, Arizona's Jan Brewer was signing and defending her state's racial-profiling bill, SB 1070. In Ohio, John Kasich championed a law-later repealed by voters-to strip public employees of bargaining rights. In Florida, Rick Scott has pushed a plethora of hard-right policies, from drug screening of welfare recipients and government employees to reductions in early voting. Michigan's Rick Snyder, who has a moderate streak, went to the extreme last December when he approved "right to work" legislation in a state built largely by union labor.
Yet Brewer, Kasich, Snyder, and Scott are among the nine GOP governors who have staked considerable political capital on Medicaid expansion, a key piece of the Affordable Care Act. They haven't been quiet about it, either. Brewer made good on a threat to veto every piece of legislation that came before her until lawmakers sent her a bill to expand Medicaid. Snyder rankled his party when he told recalcitrant Republican state senators to "take a vote, not a vacation." Scott was among the first Republicans to announce his support for expansion. Kasich, struggling to win support from his party's lawmakers, has vowed to find a way to expand Medicaid even if they won't.
All this, while in Congress, the Tea Party Republicans have worked tirelessly to shut down the government rather than see the Affordable Care Act continue, marking it as the emblem of Obama's big-government liberalism.
By championing Medicaid expansion, these governors are defying the Tea Party, which was instrumental in their elections. Such defiance has been exceedingly rare from Republican officeholders on any level since the Tea Party revolution of 2010. That election transformed state legislatures and governors' mansions-in many cases overnight-into ideological strongholds. Increasingly, the policy priorities of national right-wing groups like ALEC and Americans United for Life began to take precedence over state-specific agendas, and bipartisanship disappeared from state capitols almost as thoroughly as it has Congress. "The broader pathologies of our politics have clearly moved to the state level," says Norman Ornstein, resident scholar at the American Enterprise Institute and co-author with Thomas Mann of It's Even Worse Than It Looks, which made the case that Republican extremism and hyper-partisanship has crippled Congress.
But Kasich, Snyder, and Scott govern states that Obama has won twice. They have all struggled with low approval ratings and polarized the electorate with their far-right policies. They all face tough battles for re-election in 2014. By backing Medicaid, they were guaranteed to inspire Tea Party wrath. By opposing it, they would deny health coverage to huge numbers of low-income residents, shut the door on billions in federal funding, and risk further alienating voters.
"Republican governors are caught in a tug-of-war between arithmetic and ideology," says William Galston, a senior fellow at the Brookings Institution. "For some of them, ideology wins, and for others, who are looking to their self-interest and the interests of their state at least in the short to medium term, they have done a very simple calculation and that is that the Medicaid expansion is a good deal for their states."
There's little denying that Medicaid expansion to cover many more adults, is a good deal for every state. For the first three years, the federal government will pick up 100 percent of the cost for new recipients. After that, states will never pay more than 10 percent of the costs of expanded coverage; the rest of the bill goes to Washington. In Ohio alone, more than 500,000 people would gain access to coverage. With more people covered, of course, the costs to states of uncompensated care will drop. In June, a report from the Rand Corporation found that the first 14 states that opted out of expanding Medicaid will have 3.6 million more uninsured residents, lose $8.4 billion a year in federal payments, and pay an additional $1 billion in uncompensated care in 2016.
The arithmetic hasn't been enough to convince most Republican governors to back Medicaid. Sixteen of the 30 oppose expansion, including the chief executive of another state Obama won twice, Wisconsin's Scott Walker. Three other GOP governors had yet to venture a position.
Then there's Pennsylvania's Tom Corbett, a governor emblematic of the dilemma facing unpopular Republicans in swing states. Obama won Pennsylvania by 11 points in 2008 and by 5 points in 2012. But Corbett, who won in the 2010 wave, has stuck to the Tea Party agenda on everything from voter ID to welfare cuts. He was quick to announce that his state would reject federal funds for Medicaid expansion.
Under enormous pressure, however, he changed his mind, and last week announced he would support Medicaid expansion if the federal government agreed to a slew of concessions. Unlike Walker, a strong favorite in 2014 thanks to weak and divided opposition following a failed recall attempt, Corbett is among the most vulnerable incumbents in the country. Corbett is now trying desperately find some political path to moderation-though it's likely to be too little too late and it stands in contrast to those like Snyder and Kasich, who actually took the lead on the issue.
That a minority of Republican governors has backed Medicaid expansion does not add up to a major shift in the political dynamic. But it could be significant, depending on the outcome of the 2014 elections. If a governor like Scott or Kasich can manage to win re-election even after infuriating his right-wing base on a key issue, it will send a couple of important messages to other Republicans, at least those in purple states: Yes, the Tea Party can be bucked. And no, making policy based on the needs of your state does not amount to certain political death. It might even save you from it.
