ACA divide is national, not local

If you turned on the TV or read the news in 2017, it’s likely you encountered coverage related to the Affordable Care Act. On the congressional level, it appeared that Democrats and Republicans were embattled over the issue of repeal and replace; however, upon zooming out, it’s clear that the political dynamics were not that simple. In fact, it appears that in 2017, the Republican Party was partly divided over the ACA on the national and state level.

The Brookings Institution’s Molly Reynolds illustrated this intra-party divide in her April 11 presentation at UNLV, “When Interests Collide,” which focused on the complex relationship between Republican state governors and national GOP congressional members over the ACA.

While it seemed Republicans were nearly universally opposed to the ACA on the national level, Reynolds indicated that this wasn’t quite the case on the local and state level. In fact, since the implementation of the Affordable Care Act, 32 governors — 11 of whom were Republicans — have expanded Medicaid.

Reynolds’ analysis of more than 900 mentions of governors’ stances on the ACA in the news media illustrates a wide range of participation. Of 17 governors analyzed, five were term-limited, seven were seeking re-election and five were not running again.

Term-limited governors averaged 40 mentions; those seeking re-election averaged 20 mentions; and those not seeking re-election averaged 15 mentions. Reynolds contended that these results demonstrated that electoral incentives did not drive the behavior of these governors. Given that the most mentioned governors were term-limited, it appeared that their qualms over repeal efforts were based primarily in the policy implications.

The most substantial effect of repeal policies would be cuts to federal funding for Medicaid-expansion programs.

Upon reviewing state-by-state losses and gains of funding for Medicaid, Reynolds found that all eight governors who opposed the repeal would lose funding, while supporters had mixed funding results. This could indicate that some Republican governors transcended the partisan politics that has gripped the national level.

One of these contrarians was Nevada Gov. Brian Sandoval. As a leading opponent to repeal, Sandoval issued four statements to members of Congress in 2017 that articulated his frustrations over the repeal process.

Reynolds projected that if the Affordable Care Act had been repealed, Nevada could have lost upward of $1 billion in federal funding for Medicaid programs. These financial losses would have been catastrophic for the thousands of families in Nevada who rely on Medicaid.

Sandoval’s refusal to cling to national partisanship was not an electoral ploy but a true victory for Nevadans, not just those reliant on Medicaid. His defense of Medicaid funding squarely opposes Republican Sen. Dean Heller, who authored a repeal and replace bill in September.

This tension apparent in the national-state Republican relationship in Nevada epitomizes the divide. In the midterm elections, Republican voters will likely question the platforms of their national representatives while Democratic voter participation surges as a reaction against national Republican legislators. These voting behaviors may have electoral implications in places where this tension is present.

Ultimately, the colliding of interests within the Republican Party should begin to peel away the political tribalism that has taken grip of politics on the national level. More so, it signals the possibility for a political shift in which policymaking is not dictated by special interests or electoral outcomes, but by sensible policy assessments and analyses.