GOP governors are divided over what to do about Medicaid expansion, but their actions thus far line up with poll data
Republican governors across the US are split on whether to accept additional federal funding to expand Medicaid. Some such as New Jersey Governor Chris Christie and Florida Governor Rick Scott have said yes in order to get more federal dollars, while Indiana Governor Mike Pence and Wisconsin Governor Scott Walker have declined. Why? From a public opinion standpoint, Republicans face a catch-22: the majority of Americans want the expansion, but the Republican base doesn’t.
Per a January Kaiser poll, 52% of Americans believe the Medicaid expansion should go into effect vs. the 42% who think Medicaid should be kept the way it is. That’s far more popular than the 2010 Patient Protection and Affordable Care Act at large, which 52% of Americans want to try to change or stop to ensure it has “less impact on taxpayers, employers, and health care providers”.
When we expand it to the state level, the polling picture looks similar. The percentage of adults who believe Medicaid should be expanded after being told the state would have to pay 10% of the cost after three years is 54% in Arkansas, 62% in Florida, 51% in Kansas, and 55% in Texas. Perhaps most impressive is Iowa where more adults believe that the state should opt-in on the expansion even after being presented with Republican Governor Terry Branstad’s arguments against it.
The issue for Republican governors is that the Republican base just doesn’t agree. In the national Kaiser poll, only 16% of Republicans believe expanding Medicaid should be a “top” priority, and a mere 23% of Republicans believe that Medicaid expansion should be done at all.
The same holds on the state level. In Florida support from Republicans is 25 points lower than it is for the public at large. In the blue state of New Jersey, only two-fifth’s of Republicans like Medicaid expansion. In the swing state of Iowa, nearly four-fifth’s of GOP voters agree with Governor Branstad’s arguments against the exchange.
The result of these competing factions is a bunch of Republican governors don’t know what to do. Republicans know that the majority of the public thinks they are too extreme and unwilling to compromise. The last thing they need to do for their re-election efforts is to oppose a program that seems to be popular with the residents of their states. That’s especially the case governors with low approval ratings in purple states like Rick Scott.
At the same time, Republican governors know that conservative voters have shown very little restraint in taking out Republicans who don’t toe the party line. Former Florida Governor Charlie Crist hugged President Obama, which was the picture in the opening ad for the insurgent run for senate of Marco Rubio. Long-time Indiana Senator Dick Lugar was apparently too nice to Obama, so he received a successful primary challenge in 2012.
The same pattern seems to be occurring to Chris Christie in New Jersey and Rick Scott in Florida. Conservatives refused to invite Christie to CPAC, despite the fact that he is arguably the most conservative elected New Jersey governor in an incalculable number of years. A CPAC insider said Christie’s future role in the national Republican Party is “limited”. Christie’s exclusion is no doubt because of a number of factors such as gun control and his post-Sandy Obama love, but few would doubt that the Medicaid expansion played a roll.
Meanwhile members of Governor Scott’s own cabinet have called his move on medicaid “surrender”. Florida Attorney General Pam Bondi opposed the move and has been polled as a potential primary challenge to Scott. That’s right, there’s some chatter that Rick Scott ,who is one of the most conservative governors in the nation, might face a primary challenge.
To add to the intra-party squabbles, the normally Republican and high donation giver Hospital Associations are fearful of losing money if the Medicaid expansion is not taken by governors. They have lobbied hard. No doubt Rick Scott, a former hospital executive, was at least partially swayed by them. Most other conservative groups are, like most Republicans, against the Medicaid growth.
So what is a Republican governor to do from a re-election angle? If you’re in a deep red state, oppose the expansion. It’s doubtful that a deep red state will support a Democratic governor over this one issue. You’ll only increase the chance of a primary challenge. If you’re in a purple or blue one and potentially vulnerable for re-election, support it. You’ll get money help from the Hospital Associations to help in the primary and general elections. You also don’t want to be seen in the same lens of a national party that is already facing quite low approval ratings.