Some Republican governors and U.S. senators are going to have a major Obamacare dilemma on their hands if they wake up Wednesday morning and find that their party controls Congress.
Congressional Republicans repeatedly have vowed to repeal the Patient Protection and Affordable Care Act. Sen. Mitch McConnell, (R-Ky.), who the polls show is likely to be re-elected and become the next Senate majority leader, was forced by conservatives last week to retract his statement that a Republican Congress would not be able to repeal the law. He issued a statement reiterating his implacable commitment to abolishing the healthcare reform law.
Similarly, Ohio's Republican Gov. John Kasich last month was pressured to backtrack and “clarify” his comments to the Associated Press that a GOP-controlled Senate would not repeal Obamacare. Other Republicans also have been caught in this box.
Both McConnell and Kasich face the quandary that their states have implemented popular and successful expansions of Medicaid coverage to adults earning up to 138% of the federal poverty level. In addition, tens of thousands more residents of their states have gained coverage in private plans through the Obamacare insurance exchanges. Kasich personally fought to push through Medicaid expansion over the fierce opposition of state Republican lawmakers.
Both men have had to distinguish the coverage expansions in their state from Obamacare, with tortuous results. McConnell argued that the popular portions of Obamacare, such as the successful state-run Kynect exchange and the Medicaid expansion, could remain even if the law were repealed. That claim was quickly knocked down. “People would not be able to get subsidies if the Affordable Care Act were repealed and states could not have the Medicaid expansion,” Carrie Banahan, Kynect's executive director, told WFPL News.
Even conservative pundits have pointed out that arguing for keeping the Medicaid and exchange coverage expansions while repealing the ACA makes no sense because a repeal would wipe out the hundreds of billions in funding that make those coverage expansions possible. Some have argued that Republicans will have to lay out an alternative healthcare reform scheme, including funding mechanisms, that enables Americans who gained coverage under Obamacare to remain insured.
But McConnell was sticking to his argument as of last week. Kentucky “operated Medicaid before Obamacare,” a McConnell spokesman told WFPL News. “The state can continue to operate Medicaid after Obamacare. There were online health insurance marketplaces before Obamacare. There are several non-Obamacare insurance sales websites now that are not part of Obamacare. There can be online insurance sales without Obamacare. Obamacare did not create the ability to buy insurance online – people have been doing that for years.”
The only problem is a little thing called money. After Kasich argued that “I have favored expanding Medicaid, but I don't really see expanding Medicaid as really connected to Obamacare,” conservative analyst Dr. Avik Roy skewered him in Forbes. “But this makes no sense,” Roy wrote. “35 percent of Obamacare's increased spending on the uninsured—$644 billion from 2013 to 2022—is projected to come from the law's expansion of Medicaid.”
Stay tuned to see how the Republicans square this circle in the coming weeks and months.
Follow Harris Meyer on Twitter: @MHHmeyer
