Southern governors form solid block against Obamacare

Saturday, March 30, 2013 at 1:39pm

ATLANTA — As more Republicans give in to President Barack Obama's health-care overhaul, an opposition bloc remains across the South, including from governors who lead some of the nation's poorest and unhealthiest states.

"Not in South Carolina," Gov. Nikki Haley declared at the recent Conservative Political Action Conference. "We will not expand Medicaid on President Obama's watch. We will not expand Medicaid ever."

Widening Medicaid insurance rolls, a joint federal-state program for low-income Americans, is an anchor of the law Obama signed in 2010. But states get to decide whether to take the deal, and from Virginia to Texas — a region encompassing the old Confederacy and Civil War border states — Florida's Rick Scott is the only Republican governor to endorse expansion, and he faces opposition from his GOP colleagues in the legislature. Tennessee's Bill Haslam, the Deep South's last governor to take a side, added his name to the opposition on Wednesday.

Haley offers the common explanation, saying expansion will "bust our budgets." But the policy reality is more complicated. The hospital industry and other advocacy groups continue to tell GOP governors that expansion would be a good arrangement, and there are signs that some Republicans are trying to find ways to expand insurance coverage under the law.

Haslam told Tennessee lawmakers that he'd rather use any new money to subsidize private insurance. That's actually the approach of another anchor of Obama's law: insurance exchanges where Americans can buy private policies with premium subsidies from taxpayers.

Yet for now, governors' rejection of Medicaid expansion will leave large swaths of Americans without coverage because they make too much money to qualify for Medicaid as it exists but not enough to get the subsidies to buy insurance in the exchanges. Many public health studies show that the same population suffers from higher-than-average rates of obesity, smoking and diabetes — variables that yield bad health outcomes and expensive hospital care.

"Many of the citizens who would benefit the most from this live in the reddest of states with the most intense opposition," said Drew Altman, president of the non-partisan Kaiser Family Foundation.

So why are these states holding out? The short-term calculus seems heavily influenced by politics.

Haley, Haslam, Nathan Deal of Georgia and Robert Bentley of Alabama face re-election next year. Mississippi Gov. Phil Bryant is up for re-election in 2015. Louisiana Gov. Bobby Jindal is term-limited at home but may seek the presidency in 2016. While they all govern GOP-leaning states, they still must safeguard their support among Republican voters who dislike large-scale federal initiatives in general and distrust Obama in particular. Florida's Scott, the South's GOP exception on expansion, faces a different dynamic. He won just 49 percent of the vote in 2010 and must face an electorate that twice supported Obama.

A South Carolina legislator put it bluntly earlier this year. State Rep. Kris Crawford told a business journal that he supports expansion, but said electoral math is the trump card. "It is good politics to oppose the black guy in the White House right now, especially for the Republican Party," he said.

Whit Ayers, a leading Republican pollster, was more measured, but offered the same bottom line. "This law remains toxic among Republican primary voters," he told The Associated Press.

At the Tennessee Hospital Association, president Craig Becker has spent months trying to break through that barrier as he travels to civic and business groups across Tennessee. "It's really hard for some of them to separate something that has the name 'Obamacare' on it from what's going to be best for the state," he said, explaining that personality driven politics are easier to understand than the complicated way that the U.S. pays for health care.

Medicaid is financed mostly by Congress, though states have to put in their own money to qualify for the cash from Washington. The federal amount is determined by a state's per-capita income, with poorer states getting more help. On average in 2012, the feds paid 57 cents of every Medicaid dollar. It was 74 cents in Mississippi, 71 in Kentucky, 70 in Arkansas and South Carolina, 68 in Alabama. Those numbers would be even higher counting bonuses from Obama's 2009 stimulus bill.

Obama's law mandated that states open Medicaid to everyone with household income up to 138 percent of the federal poverty rate - $15,420 a year for an individual or $31,812 for a family of four. The federal government would cover all costs of new Medicaid patients from 2014 to 2016 and pick up most of the price tag after that, requiring states to pay up to 10 percent. The existing Medicaid population would continue under the old formula. In its ruling on the law, the Supreme Court left the details alone, but declared that states could choose whether to expand.

Hospital and physician lobbying groups around the country have endorsed a bigger Medicaid program. Becker said he explains on his road show that the Obama law paired Medicaid growth with cuts to payments to hospitals for treating the uninsured. Just as they do with Medicaid insurance, states already must contribute their own money in order to get federal help with those so-called "uncompensated care" payments.

The idea was instead of paying hospitals directly, states and Congress could spend that money on Medicaid and have those new beneficiaries — who now drive costs with preventable hospital admissions and expensive emergency room visits — use the primary care system. But the Supreme Court ruling creates a scenario where hospitals can lose existing revenue with getting the replacement cash Congress intended, all while still having to treat the uninsured patients who can't get coverage.

Becker said that explanation has gotten local chambers of commerce across Tennessee to endorse expansion. "These are rock-ribbed Republicans," he said. "But they all scratch their heads and say, 'Well, if that's the case, then of course we do this.'"

In Louisiana, Jindal's health care agency quietly released an analysis saying the changes could actually save money over time. But the Republican Governors Association chairman is steadfast in his opposition. In Georgia, Deal answers pressure from his state's hospital association with skepticism about projected "uncompensated care" savings and Congress' pledge to finance 90 percent of the new Medicaid costs.

Altman, the Kaiser foundation leader, predicted that opposition will wane over time.

Arkansas Republicans, who oppose Democratic Gov. Mike Beebe's call for expansion, have floated the same idea as Haslam: pushing would-be Medicaid recipients into the insurance exchanges. Jindal, using his RGA post, has pushed the Obama administration to give states more "flexibility" in how to run Medicaid.

Deal convinced Georgia lawmakers this year to let an appointed state board set a hospital industry tax to generate some of the state money that supports Medicaid. That fee — which 49 states use in some way — is the same tool that Arizona Gov. Jan Brewer is using to cover her state's Medicaid expansion. Georgia Democrats and some hospital executives have quietly mused that Deal is leaving himself an option to widen Medicaid in his expected term.

"These guys are looking for ways to do this while still saying they are against 'Obamacare,'" Altman said. "As time goes by, we'll see this law acquire a more bipartisan complexion."

21 Comments on this post:

By: pswindle on 3/30/13 at 3:43

When the people of these southern states start to suffer even more, they will come around. Democrats wake up, the south will rise again. I wonder if these southern governors would behave like this if our President was not black? All you can say they are mean to the core.

By: Rasputin72 on 3/30/13 at 5:10

The Governors of every southern state have seen the intellectual futility of the
.underclass. They have seen the reckless birthrate. They have seen the acceptance of pverty. They have seen the propensity for criminal behavior.

The birth rate alone of "these people" is enough to overwhelm the peoductive citizens of eery southern state and ultimately our demoxracy and our country.

By: Ask01 on 3/30/13 at 5:58

I am always baffled when people consciously vote against their own best interest. When the economic squalor combined with near rock bottom health statistics abundant in the south, the expectation should a solidly Democratic region.

Instead, the citizens, at least those voting, continue to back the party least concerned with their well being.

Now, the leadership in these backwards states is working to actively deny citizens healthcare. All seemingly because a black man sits in the White House and is pushing the issue.

When the backlash comes, as it inevitably shall, I will be incredibly amused by the antics as Republicans try to salvage their sinking party.

By: Rasputin72 on 3/30/13 at 8:03

ASKOI..I hardly think the proper word is backlash. It is and will ultimately be sheer numbers In a democracy if there are more have nots than haves, the have nots can accomplish almost anything politically. That includes free stuff. Unfortunately the have nots are from a historical perspective not a class of deep thinkers. Ultimately this intellectual fault will destry the entire democracy.

It is called being over leveraged. Not enough haves to support the overweighted have not class. Pure mathmatics.

You are correct in that within the next decade the have nots will be the controlling class.

You are incorrect in your statement that all this is becsuse we have a black President. It is because the productive class does not want to take on the additional burden of more taxes andand the increased cost of subsidizing the have nots.

By: pswindle on 3/31/13 at 11:00

Well, Well, Well, What else would you expect!

By: Radix on 3/31/13 at 11:12

Funny libs bankrupt Chicago, Detroit and California, then think their policies would be good for "poor southern states" too? What baffles me Ask01, is how after all the hypocrisy, broken promises and lies of Obama that anyone would dare defend him... I thought debt was "unpatriotic"? I thought transparency was the way to go? I thought earmarks would be ended, and we would be united? Poor brainwashed sheep. Talk about cult of personality, you people are so brainwashed that Obama could eat kittens and you would defend it... unreal.

Way to go Haley and Haslam. Obama can bankrupt the Federal Gov't but he can't force us to bankrupt our states. It was just reported that California has a negative net worth. Maybe Ask01 should move there. Just say no to the Democrats unsustainable agenda. Southern states have their own issues to solve without Obama making things worse.

By: Captain Nemo on 4/1/13 at 3:31

Rasputin and intellectual in the same sentences is a joke. Stones.

By: Captain Nemo on 4/1/13 at 3:33

It was the Republican that bankrupt California.

By: Libertine on 4/1/13 at 4:34

Obamacare increases the cost of health care claims by 32%. Increasing the cost of health care will ultimately result in fewer people having access to quality health care. Obamacare is the opposite of health care reform.

By: Loner on 4/1/13 at 6:26

Here it is, in a Southern Nutshell:
A South Carolina legislator put it bluntly earlier this year. State Rep. Kris Crawford told a business journal that he supports expansion, but said electoral math is the trump card. "It is good politics to oppose the black guy in the White House right now, especially for the Republican Party," he said.

Nothing more than residual white supremacism in the Old Confederacy states....618,000 soldiers and sailors died in the Civil War, and the South still remains unrepentant, ignorant and filled with hate...they still blame the victims....the African Negro slaves.

Abe Lincoln screwed up...should have let the A-holes go their own way....they just do not get the idea that all men are created equal....they prefer rule by royal family aristocrats, as opposed to true Constitutional democracy....the South is not up to speed and never will be.....throw them out of the union of American States.

Instead of secession, the US should just eject these states from our union of states...cut off all the federal money....they would implode in a few weeks....then the US could reconquer the South and turn the entire region into a federally-administered territory....no more statehood for the these racist haters.

By: Kosh III on 4/1/13 at 6:44

Radix
California had catastrophic budget issues because of the REPUBLICANS.

1983-2011
5 years of a Democratic governor
23 of Republicans 83-91 Dukmejian; 91-99 Wilson, 03-11 Schwarzenhimmler

The budget required a 2/3 majority and the GOP minority held an effective veto over the budget so the fiscal problems were consisistently kicked down the road because the GOP refused to accept any new revenue and demanded cuts.
Finally a referendum changed the process to a majority vote and now the current, very frugal Democratic governor is well on the way to fixing the problems caused by GOP obstruction.

By: Loner on 4/1/13 at 7:19

The Tea-Party infused Republicans have consistently denigrated the PPACA Law...calling it "Obamacare"... it's difficult, if not impossible for them to now support any part of the legislation....Supreme Court decisions notwithstanding.

The right-wingers have painted themselves into a corner on "Obamacare"....they are now stuck in that obstructionist and rebellious position....this may prove to be a good thing down the road, as reasonable people are now leaving the Party of Jefferson Davis in droves...Florida could turn blue...Texas too...the Republicans invited the haters into their fold in 1968....the chickens have come home to roost.

By: Loner on 4/1/13 at 7:26

If it were not for the NFL, NBA, MLB and NHL the union of American States might become unglued....truly this is governance by way of bread and circus....panem et circum

Trouble is...we may be running out of bread.

By: Kosh III on 4/1/13 at 7:32

Regarding California, this is what one Nobel Prize economist says:
http://www.nytimes.com/2013/04/01/opinion/krugman-lessons-from-a-comeback.html?_r=1&

In short, The GOP obstructionists were to blame.

By: Loner on 4/1/13 at 7:34

The NCP's headline for this thread is already biased, it reads: Southern governors form solid block against Obamacare

If the NCP had put the word "Obamacare" in quotation marks, it would not have appeared to be biased against the PPACA legislation...using that derogatory term, without quotation marks, puts the NCP on the right-wing side of the debate....or leaves that impression.

By: Loner on 4/1/13 at 7:40

If I were advising the POTUS, I might suggest that he summon these rogue governors to the White House...maybe a weekend at Camp David....and then shame the SOB's for their race-based obstructionism...shove SC State Rep. Kris Crawford's frank and honest analysis in their faces....make them admit their racism and make them repent of it, if possible....a little epiphany inducement may be called for at this time....why not give it a shot?

By: pswindle on 4/1/13 at 7:53

I hope that President Obama does not give them one penny of federal money to pay the insurance companies for their support in election time. Gov. Haslam is begging for federal money because he knows best. That's a laugh, he is paying back his buddies. You and I know that if he gets his way, no better care and no one else will be added to the roll.

By: Loner on 4/1/13 at 8:06

Pswindle, you are right, this is corporate welfare...taxpayer monies go to private insurers, so that "the poor" get coverage....a situation ripe for exploitation at the local level.

There is no superior substitute for single-payer national healthcare systems....As Kosh pointed out, several advanced Western nations have managed to do it right, but we Americans stubbornly put patch after patch on a system that is failing, rather than follow somebody else's lead....American Arrogance?

American Exceptionalism does not allow for imitating successful foreign- borne ideas and/or policies....the NIH factor...Not Invented Here...is alive and well in the USA.

By: Jughead on 4/1/13 at 10:34

People who support Obamacare are freeloaders, and those who need freeloaders' votes.

By: 4gold on 4/2/13 at 7:08

The problem with public health care is that it is alwaya abused. If the poor want healthcare I say just send them to Canada. America can't afford them. Right Resputin?

The republicans preach spending cuts but truth is they spend just like the dems do. They just want to spend on their war monger weapons companys instead of domestic spending. We would be attacking Iran right now if Obama had not been reelected and plumiting into deeper depression. Obama got us out of the GW Bush mess he left. Maybe the south will wake up one of these days but I am not holding my breath.

Go Dores, Preds, Titans! Go Nashville a great place to live!

By: Specter47 on 4/2/13 at 9:27

Hey, pswindle... what would you say if these same Southern governors made the same decision and Obama was white? It takes an ignorant jackass to not know that Governor Nikki Haley of South Carolina is of Indian decent. Play that race card, doofus. All you do is stir people up. Typical liberal democrat. No where else to go but to an emotional, unfounded, and ignorant charge of racism.