How Obamacare Is Splitting Republicans


Senator David Vitter, who is running for governor in Louisiana, is flirting with Obamacare’s Medicaid expansion:

Republicans have found they have a good deal of leverage in using the Medicaid expansion to request state-based reforms, which require a federal waiver, from the expansion-supporting Obama administration. Arkansas pioneered the unique approach with a private option that uses Medicaid dollars to enroll people into private insurance plans through Since then, MichiganIowaIndiana, and New Hampshire have adopted their own reform-pegged expansions.

Whether Vitter actually becomes governor and manages to expand Medicaid is, of course, an open question. But at the very least his current support for a reform-based expansion shows the growing schism among Republicans about whether they should approve the Medicaid expansion

It’s worth noting that Vitter’s support of expansion is conditional:

In an email to The Wire a Vitter spokesperson wrote that any support of the expansion would depend on fixing the program: “The only way Senator Vitter would ever consider any expansion is if it fundamentally reformed the program, did not continue to drain state dollars way from higher ed, and did not provide additional disincentives for able-bodied folks to work, all factors he laid out clearly.”

Still, Igor Volsky sees Vitter’s maneuvering as part of a trend:

Vitter’s comments come as a growing number of Republicans are re-evaluating their opposition to Medicaid expansion. In May, Senate Minority Leader Mitch McConnnell (R-KY) expressed support for growing Medicaid by arguing that the process could be controlled by the state. Indiana Gov. Mike Pence (R), a possible 2016 presidential candidate, has also announced that he would apply for a waiver that would allow Indiana to provide private coverage to its residents using funding secured by the Affordable Care Act. In total, nine Republican governors have backed Medicaid expansion, and the provision is also being embraced by vulnerable Democrats up for re-election, including Louisiana’s Mary Landrieu (D) and North Carolina’s Kay Hagan (D).

Beutler makes similar points:

[Vitter is] no stranger to the scatter-rightward impulse. But he’s also seen Louisiana’s unpopular current governor Bobby Jindal struggle with the absolutist position on Obamacare, and wants to replace Jindal who’s up against a term limit in 2015. So Vitter’s is actually triangulating against the current governorbanking against the possibility that some other hardliner will outmaneuver him. Vitter still boasts of his efforts to repeal Obamacare on his Senate website. But running anti-Medicaid expansion isn’t good politics. Even in Louisiana.

This kind of doublespeak isn’t new. But as Affordable Care Act enrollment inches toward 9 million, skeptical carriers announce that they’ll enter the marketplaces next year, and others announce nominal premium hikes, it’s becoming common in more and more conservative states.