Good post on the Bill of Health blog from Emma Sandoe, former spokesperson for the federal Center for Medicare and Medicaid Services (CMS), giving a quick overview of the status of Medicaid expansion in the four early primary states: Iowa, New Hampshire, South Carolina, and Nevada. Of the four, only South Carolina has rejected Medicaid expansion; Iowa and New Hampshire are using federal waivers to pursue their own unique versions, like Arkansas (and both use a “private option” approach for some beneficiaries). 

It’s been interesting to watch the impact of Medicaid expansion on GOP presidential politics. Obamacare has been a more muted issue than I expected in the primaries thus far. The race featured two governors who backed Medicaid expansion — Chris Christie of New Jersey and John Kasich of Ohio. Christie has now dropped out, while Kasich surged to a strong second in New Hampshire. Is a vote to accept federal Obamacare money disqualifying in a national GOP race? It’s hard to isolate any one factor in a race this crowded, but it’s hard to detect much of an impact on either candidate (Christie had bigger problems than Obamacare apostasy). The candidate who has dominated the field, Donald Trump, has breezily said that universal health care — even including single payer — might be fine and dandy, although he dutifully says he hates Obamacare.

I had kind of thought that backing Medicaid expansion would ultimately be a dealbreaker in the GOP primary race and wrote off Christie, Kasich, or other potential candidates like Mike Pence of Indiana. But Trump’s dominance despite his dalliances with liberal positions on health care and Kasich’s relatively strong early showing despite bringing Medicaid expansion to Ohio — well, it’s enough to make me wonder. (Kasich is especially hated by anti-Obamacare activists because he frequently evokes his Christian faith to explain his decision.) Is capitulation to Medicaid expansion quite the political poison in Republican primaries that you might think? After all, this crew nominated Mitt Romney, of Romneycare fame! 

Jeb Bush has begun to test how deep of a liability this is for Kasich, turning up his attacks on Medicaid expansion. One line that Bush has been using is that a true conservative governor wouldn’t do that. This led D-G columnist John Brummett to tweet, “You hear that, Asa?” 

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The governor responded: 

Brummett said that the point was that it sure sounds like Bush is saying a true conservative governor wouldn’t do what Hutchinson is doing right now (and that GOP state lawmakers shouldn’t go around trashing Obamacare if they opt in to Medicaid expansion and rely on it). 

The ongoing civil war within the Republican party in Arkansas over the private option will continue regardless of what happens in the GOP primaries, but it’s probably better for Hutchinson and other Republicans backing the private option if the issue of Medicaid expansion stays relatively quiet in the national campaign. 

Support for special health care reporting made possible by the Arkansas Public Policy Panel.