Republicans Changing Tune — but not Shifting Critical Tone — on Medicaid

In 2009, Rick Scott founded Conservatives for Patients’ Rights, a health care pressure group opposed to President Obama’s health reforms.

In 2010, Scott ran for governor of Florida on a mission to repeal Obamacare.

In 2012, Scott … will work to implement Obamacare.

For some conservatives, it’s a shocking reversal. Leaders of Americans for Prosperity, the conservative organization backed by the influential Koch brothers, were publicly disappointed in the Florida governor — who not so long ago said the Affordable Care Act was “the biggest job killer in the history of the country.”

Now, it will be Scott’s job to help implement it.

Changing Tune

Given his prominence, Scott’s move from Obamacare opponent to grudging supporter may be the biggest symbolic shift on the law since its passage.

The Florida governor was reportedly pressured by state legislators to negotiate with federal officials over the ACA, once November’s election made clear that Obamacare was here to stay.

But Scott won’t be the last GOP official to change his tune. More health care groups in other Republican-led states are putting similar pressure on their leaders to opt into the ACA’s Medicaid expansion, in hopes of securing additional dollars for providers.

And some prominent conservative thinkers are shifting their stance, too.

“Opposing Obamacare is no longer enough,” according to Avik Roy — a former Romney-Ryan campaign adviser and prominent ACA critic — who weighed in at National Review.

“We will have to accept that repealing Obamacare is no longer possible, and instead step back and look at the health-care system as a whole and ask: If we were designing a health-reform agenda from scratch, what would it look like?” Roy wrote.

Ongoing Criticism of Medicaid

Many of those reform principles still center around Medicaid, and whether it’s possible to transform how the program is funded and works with the states.

Some argue that those changes aren’t just necessary — they’re overdue.

“We believe that significant, fundamental reform to save, strengthen and secure Medicare and Medicaid are imperative,” Rep. Tom Price (R-Ga.) told The Hill this week.

A number of Republicans say that they still favor House Budget Committee Chair Paul Ryan’s proposal to block-grant the Medicaid program in hopes of slowing spending. That plan is expected to come up in congressional debate over a deficit deal this winter, although it is extremely unlikely to be adopted, given Democrats’ control of the Senate and the White House’s desire to protect Medicaid funding as a key part of the ACA.

However, Ryan’s aggressive reforms may allow GOP negotiators to “set the goalposts” and try to win some lesser compromise, one Capitol Hill health staffer told California Healthline. For example, Republicans are expected to push for concessions on the pace and size of the ACA’s Medicaid expansion.

GAO Affirms Medicaid Quality of Care

But Republicans arguing to scale back the Medicaid expansion may have lost one of their key attack lines this month.

One of the major conservative criticisms against Medicaid is that the program is poorly funded and leads to substandard care — in some worst-case scenarios, critics charge, obtaining Medicaid coverage creates more access problems for patients than being uninsured.

“The academic literature has consistently illustrated that Medicaid patients have poorer access to care, and poorer health outcomes, than privately insured patients,” according to a Heritage Foundation research brief.

But that’s not the case at all, according to a recent report by the Government Accountability Office.

While Medicaid reimburses physicians at a lower rate than private insurance, beneficiaries’ access to medical care is comparable to individuals with private insurance, the GAO concluded.

That finding reinforces what researchers like Harold Pollack and Aaron Carroll have long argued: Medicaid’s benefits are too often overlooked and the program’s quality of care is drastically misreported.

New Analysis Will Be at Center of Lobbying

Meanwhile, another new study has moved to center stage of the policy debate this week: a report released by the Kaiser Family Foundation and conducted by researchers from the Urban Institute on states’ costs and benefits from adopting the Medicaid expansion.

The researchers found that states will have to spend millions more on Medicaid over the next decade regardless of whether they join the ACA expansion — but states could reap billions in additional federal dollars if they choose to participate.

Those findings already are influencing debate over state participation in the program. For example, Alaska health care advocates are using the KFF/Urban analysis to lobby Gov. Sean Parnell in hopes of convincing the Republican governor to opt into the ACA’s Medicaid expansion. According to KFF/Urban, if Alaska joins the Medicaid expansion and lays out an additional $147 million across a decade, it will receive another $1.5 billion in federal funds for the program.

Yet liberals’ overwhelming support for state Medicaid expansion, amid Washington’s persistent deficits, raises the question: Where will these Medicaid dollars come from, the Atlanta Journal-Constitution‘s Kyle Wingfield writes.

“Why is it that none of the ‘found money’ advocates ever explain how we’re going to pay for this new spending?” Wingfield asks.

“Or do they think … taxpayers will truly believe someone else will handle that federal portion of the cost?

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