A choice between Medicaid reality and rhetoric

AS OTHERS SEE IT

If the politics of health care over the past two years has proven anything, it is that Americans generally want the government to ensure that everyone has access to decent coverage, particularly the most vulnerable. The midterm elections Tuesday will test how deep into GOP territory that attitude extends.

Voters in Idaho, Nebraska and Utah, three of the nation’s most Republican states, will decide whether to expand Medicaid within their borders. The federal-state partnership covers low-income Americans, and Obamacare expanded the number of people eligible for the program. Or it tried, anyway. The Supreme Court in 2012 made expansion optional for states, and a surprising number of redstate politicians refused to boost their Medicaid rolls, leaving millions of Americans with no reasonable health insurance option, even with the rest of Obamacare in place. There was never a good reason to refuse: the federal government picks up nearly all of the tab in expansion states, and the relatively small amount states must spend is offset by big savings on other healthcare expenses for which states would have otherwise been responsible.

Opposition to expansion turned out to be unpopular as well as irrational, perhaps because the case for refusing was so bad and the costs to those affected so steep. Slowly but surely, GOP-led states have acceded to reality. Even Vice President Mike Pence, when he was governor of Indiana, expanded Medicaid in his state. After a crushing slap from voters last year, Virginia Republicans finally ended their resistance to expansion. Nevertheless, rote GOP opposition to Obamacare has led 17 other states to continue holding out.