Yesterday, Indiana governor and possible presidential candidate Mike Pence—a conservative's conservative by any measure—announced that he had come to an agreement with the federal government to accept the Affordable Care Act's expansion of Medicaid. Like other Republican governors, he wanted to change the plan a bit, just to make sure poor people knew that getting health coverage for free would be bad for their moral fiber. So the Indiana plan will charge small premiums—up to 2 percent of an individual's income—which will make only a tiny impact on the state's balance sheets, but will send a clear message to those layabouts; Pence talked about giving people the "dignity to pay for their own health insurance." (I'm sure that Pence declines to take a government handout in the form of the mortgage interest deduction, because that would undermine his dignity.)
While even a small premium can impose a hardship on people who are extremely poor—and there are other concessions Pence insisted on that will have the effect of making the coverage more stingy and giving the state the ability to throw people off—this is still extremely good news, because hundreds of thousands of people in Indiana who couldn't afford coverage before will now get covered. But Pence doesn't want anybody to get the idea that he doesn't hate Medicaid. As Dylan Scott explains, Republican governors always seem to find different names to call their Medicaid programs when they accept the Affordable Care Act's expansion, and they never utter the vile word "Obamacare," even though that's the source of the money they're taking:
But Pence might have been the boldest yet. His office effectively portrayed his state's plan as a blow to Medicaid and government-funded health care.
"With this approval, Indiana will end traditional Medicaid for all non-disabled Hoosiers between 19 and 64," Pence's office said, "and will continue to offer the first-ever consumer-driven health care plan for a low-income population."
This is actually the inverse of the way Republicans talk and act when it comes to Medicare. These Republican governors want to expand Medicaid for very practical reasons: having huge numbers of uninsured poor citizens creates a less healthy workforce, imposes costs on the state through uncompenstated care, and is generally an economic drag. Under the ACA, the federal government will pay nine out of ten dollars for expanding it, so you have to be an idiot not to take it (there are still quite a few such idiots left, of course). But in public, ideology demands that they claim that Medicaid is awful and they want nothing to do with it; in the extreme case, you get someone like Pence trying to convince people that he's striking a blow against the program by expanding it.
When it comes to Medicare, however, it's exactly the opposite. Republicans actually dislike it, precisely because it's a huge government program that works. But because it's so popular, they have to pretend in public that they're its greatest defenders. Here, for example, is an ad run by Indiana senator Dan Coats in his last election:
You've got to love that—his opponent voted "to force seniors into Barack Obama's government-run health care program, reducing the protection Medicare provides." Utterly nonsensical? Sure. But "Dan Coats will fight to strengthen Medicare," I guess by protecting it from the government. Or something.
You'll notice that every attempt by Republicans to privatize or other undermine Medicare is presented as a plan to "strengthen" it, the mirror image of how GOP governors now say they're weakening Medicaid by expanding it. Maybe someone should propose moving poor people into Medicare, which Republicans say they love so much. Then they'd have no idea what to say.