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The growing GOP divide over ObamaCare
Florida Gov. Rick Scott is just the latest foe of ObamaCare to accept the law's Medicaid expansion. And many of his fellow Republicans are not pleased
 
"While the federal government is committed to pay 100 percent of the cost, I cannot, in good conscience, deny Floridians the needed access to health care."
"While the federal government is committed to pay 100 percent of the cost, I cannot, in good conscience, deny Floridians the needed access to health care." Joe Raedle/Getty Images

In a striking reversal, Florida Gov. Rick Scott, whose state launched a lawsuit against ObamaCare, said this week that his administration would expand Medicaid as the federal law calls for, after all.

Scott explained that Florida had managed to sweeten the deal by getting the Health and Human Services Department to grant a waiver allowing the Sunshine State to shift Medicaid recipients to managed care plans after a few years. The more immediate impact, however, will be to extend Medicaid coverage to a million uninsured Floridians.

Scott tried to head off a backlash from conservatives by saying that he "cannot in good conscience deny the uninsured access to care," especially since the federal government, not Florida taxpayers, will foot the entire bill for the expansion for the first three years. Then, after a trial run, Scott says the state will be able to reassess before committing any of its own money to keep the program going. It's a strategic move, says Allysia Finley at The Wall Street Journal. Scott's poll numbers have been mired in the 30s, and he "may figure the Medicaid expansion is his ticket to re-election," because it will allow him to run as "a common-sense, compassionate conservative."

The reversal also means Scott has changed teams in the GOP's internal feud over ObamaCare, according to David Nather and Jason Millman at Politico. The fight is between "two camps of Republican governors sure to duke it out in the 2016 presidential primary — ideologues versus pragmatists." On Team Ideologue "are big-name Southern governors — like Bobby Jindal, Nikki Haley, Bob McDonnell, and Rick Perry — who have all said 'hell no' to major pieces of the law, even turning down free federal cash to expand Medicaid in their states." Scott is a "big convert" for the "more pragmatic governors who are rising Republican stars in the rest of the country — like Chris Christie, John Kasich and Susana Martinez — who've embraced pieces of the law or left the door open to doing so if there seems to be a political upside in their state."

It's an intra-party struggle that mirrors the same fight that's engulfed the Republican Party since Election Day, pitting anti-Obama hardliners against those concerned with appealing to a broader swath of voters.

And while it's a fight sure to simmer below the surface at the annual National Governors Association's meeting this weekend in Washington — where political attacks are usually reserved for crossing party lines — the rollout of the health care law will continue to be prime testing grounds for the future of the Republican Party in the runup to 2016. [Politico]

Well, Scott's low approval ratings were almost certainly the primary factor in his switcheroo, Michael Cannon, director of health policy studies at the Cato Institute and a member of Scott's 2010 transition team, tells National Review. Still, he's dreaming if he thinks there won't be a price to pay. Now, he's "vulnerable to a potential primary challenge," and he might lose some of his old supporters.

The only reason to do this is that [Scott] cares more about his re-election than stopping ObamaCare. It really calls into question his whole commitment to fighting ObamaCare. At this point, the only thing that could restore his credibility here would be if he filed a lawsuit like Oklahoma's to block the Obama administration's illegal taxes... But he's not going to win himself any allies, and he's only going to alienate his friends, so one wonders what he's thinking. [National Review]

This divide really isn't so shocking when you take a closer look, according to some analysts. It's true that, "in the span of a month, some of ObamaCare's most ardent opponents have come to embrace" the Medicaid expansion, says Sarah Kliff at The Washington Post. And, yes, that's "one of the law's most crucial programs." It's also true that Scott is the seventh GOP governor to sign up. But the math is pretty easy to understand.

These same governors have, however, also eschewed another big ObamaCare component: The exchanges. The three most recent Medicaid expansion converts — Florida's Rick Scott, Michigan's Rick Snyder and Ohio's John Kasich — have all rejected the idea of setting up the marketplace, leaving it to the feds to do the work, instead (Michigan is splitting the difference and will run its market in partnership with the feds).

Why embrace one part of the health care law — a single-payer system that will stretch President Obama's law to cover millions more Americans — while ditching the other more market-oriented aspect? It likely has to do with the big consequences for a governor who chooses not to expand Medicaid — versus the tiny reward with setting up a very complex insurance marketplace. [Washington Post]

What it boils down to, says Steve Benen at MSNBC, is that the "Medicaid expansion is a great deal for states, and should be a no-brainer for governors" who want to lower health care costs, get low-income families insured, and improve their state finances.

The only reasons Republican governors would balk is if (a) they're afraid of their party's base; (b) they plan to run for president and don't want this to be used against them in a primary; (c) they're bad at math; or (d) some combination therein. [MSNBC]

 

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