Politics & Policy

Expanding Medicaid

Early-state GOP voters are particularly wary about expanding Medicaid.

Can a Republican governor expand Medicaid in his state, as part of Obamacare’s implementation, and go on to compete for the GOP presidential nomination in 2016? A new poll suggests the answer is no.

The Foundation for Government Accountability, a free-market think-tank based in Naples, Fla., commissioned a poll of 500 likely voters in each of the first three presidential-selection states — Iowa, New Hampshire, and South Carolina. The results indicate that expanding Medicaid is phenomenally unpopular among Republican voters who intend to participate in the primaries or caucuses in those states, and that any aspiring president who did implement that change would face an uphill battle.

Advantage, Inc. conducted the poll using live calls to both landlines and mobile phones from July 8 to 10. Likely voters were defined as ones who had participated in the 2012 primaries or caucuses. Those polled were randomly selected from a database of registered voters. The poll has a margin of error of 4.38 percent.

The first question, for those wary of a slanted wording in the pollster’s inquiry, was:

The federal Affordable Care Act, commonly known as Obamacare, allows states to expand their Medicaid welfare program to provide free, taxpayer-funded Medicaid coverage to mostly working-age, non-disabled adults with no children who earn up to 138 percent of the federal poverty level. How supportive are you of Obamacare’s Medicaid expansion?

Some may say that a Republican respondent is seriously inclined to oppose anything associated with the moniker “Obamacare,” but the question begins with the Democrats’ preferred label, “the Affordable Care Act.” Some may object to the term “free” in describing Medicaid coverage, because Medicaid treatments do come with co-pays, but those are quite low — less than $4 for most treatments.

In Iowa, an astounding 76.6 percent of self-identified GOP voters said they were “very opposed to Obamacare’s Medicaid expansion,” and another 9.8 percent said they were “somewhat opposed.”

In New Hampshire, 74.7 percent of self-identified GOP voters said they were “very opposed” to the expansion, and another 9.9 percent said they were “somewhat opposed.”

In South Carolina, 73.2 percent of self-identified GOP voters said they were “very opposed,” and 9.4 percent said they were “somewhat opposed.”

One pollster not involved in this survey said he’s usually a bit wary about asking respondents about a relatively obscure policy area like Medicaid, because “inevitably you have to explain something to a respondent who knows nothing or almost nothing about it, then ask them if they support it, within about 15 seconds.” But considering Republican-base voters’ general opposition to additional spending, the results seem in line with expectations.

Governor Chris Christie of New Jersey supported expanding Medicaid for those with incomes up to 138 percent of the poverty level in his state — but insists it amounts to a small expansion, considering the state’s previously generous terms. Governor John Kasich of Ohio also supported the expansion.

Governor Mike Pence of Indiana opposed the expansion, but offered an alternative, “Healthy Indiana 2.0,” that some conservatives contend amounts to a de facto acquiescence to the Obama administration’s vision. That proposal had to be resubmitted for approval from the Department of Health and Human Services because, as an AP reporter put it, the state’s initial application “didn’t include input from a band of Potawatomi Indians.”

Governors Bobby Jindal of Louisiana, Rick Perry of Texas, and Scott Walker of Wisconsin opposed the expansion.

While it’s far from clear that the issue of Medicaid expansion would be decisive in a 2016 Republican presidential primary, the survey suggests it would be favorable ground for a rival’s attacks.

The poll asked, “If you knew a Republican governor implemented an Obamacare Medicaid welfare expansion in his or her state, how would that affect your opinion of that governor overall?” In Iowa, nearly 45 percent of GOP respondents said their opinion of that governor would “somewhat decline” and another 26 percent said it would “significantly decline.” In New Hampshire, 54 percent said “somewhat decline” and 18 percent said “significantly decline.” In South Carolina, a similar story: 50 percent said “somewhat decline” and 21 percent said “significantly decline.”

“Flip-flopping to embrace Obamacare’s Medicaid expansion has real consequences,” said Tarren Bragdon, CEO of the Foundation for Government Accountability. “GOP voters in critical early-primary states have low opinions of Obamacare’s Medicaid expansion and are very clear in their opposition to a governor who supports it. Republican governors like Mike Pence, John Kasich, and Terry Branstad [of Iowa] may have doomed their presidential campaigns before they even begin.”

Of course, the conventional wisdom is that the general public is broadly supportive of expanding entitlements — enjoying the prospect of larger benefits and putting the near- and long-term costs out of their minds. Eleven states with GOP governors have chosen to expand Medicaid, and Wyoming’s Matt Mead is considering it; Sam Wang, an associate professor of neuroscience and molecular biology at Princeton University, contends that the decision to expand Medicaid is helping Governors Susana Martinez of New Mexico, Rick Snyder of Michigan, and Kasich in their reelection bids. (Having a flawed Democratic rival in the gubernatorial race helps, of course.)

One way or another, the 2016 GOP presidential nominee will likely have to make the case against expanding entitlements while debating a Democratic rival who is determined to play the public-policy equivalent of Santa Claus and who conveniently ignores a debt currently at $17 trillion — and who knows what number it will be by 2016? A past decision to expand Medicaid will probably complicate that effort.

Jim Geraghty writes the Campaign Spot on NRO.

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