POSTED ON FEBRUARY 6, 2013:
Dancing to What Tune?
Governor might expand Medicaid after all
Let's call it the Tea Party two-step.
Across America, red state (and some swing state) governors are furiously juggling good public policy and good politics -- or what they think is good politics -- when it comes to health care.
In Arizona, notoriously finger-wagging Gov. Jan Brewer did a very public two-step when, after months of howling about Obamacare, she embraced the federal government's proposed Medicaid expansion.
In Ohio, Gov. John Kasich, another rabid Obamacare foe, did the same just this week.
In Florida, Gov. Rick Scott gave thumbs-down to the Obamacare provision for the working poor, but he's faced such withering criticism that some believe he, too, might end up do-si-doing.
In Idaho, Gov. Butch Otter turned up his nose at Medicaid expansion, at least for the moment -- but seemed to hint he eventually could pirouette and embrace recommendations from state experts to opt in.
Why all the drama?
Seems pretty cut-and-dry: It's either a good thing to expand health coverage to thousands of your state's working poor -- at no cost to your state budget, at least initially -- or it's not.
Well, there's another calculus at work -- the reelection or political career calculus.
Governors like Brewer, Kasich, Scott, and Otter surely know good public policy when they see it: The feds pay everything the first three years and just about everything thereafter. Plus, if it doesn't turn out the way they like, they can always opt out.
But these guvs also know that anything even remotely connected to Obamacare is radioactive within their party's rabid Tea Party wing. The list of Republican incumbents who failed to withstand primary challenges from their right flank grew significantly last year.
Which brings us to the Hon. Mary Fallin, governor of Oklahoma, the reddest of red states.
Early in her term, she performed the Tea Party two-step when she first accepted, then rejected a $54 million federal grant to set up a state health care exchange -- an unseemly sashay choreographed by the Legislature's uber-right ideologues.
More recently, she announced that Oklahoma would not participate in the federal Medicaid expansion, ignoring pleas from the state's hospitals, health care providers, some chambers of commerce, and reality-based lawmakers. She reiterated her position in this week's State of the State address.
It is worth noting, however, that sometimes in politics, "no" doesn't really mean no, nor "yes" yes. Sometimes it means, "That's my position now." At this moment. Subject to change.
That's why it's also worth noting that Fallin recently directed state health care officials to hire an out-of-state consultant to analyze coverage available to Oklahoma's working poor and generate proposals aimed at more affordably expanding that care.
The $500,000 contract -- half of which, ironically, is paid with federal matching dollars -- with former Utah Gov. Mike Leavitt's firm gives Fallin a little breathing room, at least temporarily, on a most contentious (at least within her party's wingnut wing) subject.
And it could afford significant political cover if Leavitt's crew opines that the Obamacare expansion is, in fact, the best alternative and Fallin opts to join Arizona's Brewer and Ohio's Kasich on next season's Dancing with the Governors.
The GOP's Tea Partiers, forever gripped by fear of (imaginary) federal tyranny, are clearly itching for a fight -- any fight -- with Uncle Sam. And they aren't likely to give Fallin a pass even if Leavitt's firm provides its GOP stamp of approval on Medicaid expansion.
But Fallin would solidify the support of the vast majority of Republicans -- especially those engaged in Oklahoma's health care industry -- who know that adding about 180,000 working poor to the Medicaid rolls will stave off bankruptcy of, if not outright extinction for, many providers, especially in rural areas.
It's not difficult to imagine that Fallin, looking ahead to a reelection campaign in 2014, is more concerned by a potential primary challenge from the uber-right than she is about general election defeat.
Barring some scandal, Oklahomans typically reelect their governors, especially one whose approval ratings are soaring into the 70 percent-plus stratosphere.
But primaries are different animals, routinely decided by the smallest of political universes. The vast majority of Republicans may be well satisfied with Fallin and thus have little incentive to make primary voting a priority. But those who don't consider her ideologically pure enough would be driven to vote and could make her electoral life a living hell.
Still, as Fallin has seen in recent days, not all Oklahomans think it's smart politics to reject $3.6 billion in federal dollars that almost assuredly will end up being spent in other states.
More than 5,000 Oklahomans have signed an on-line petition urging the governor to reconsider her opposition to the Medicaid plan.
The Legislature's Democratic leaders, Sen. Sean Burrage of Claremore and Rep. Scott Inman of Del City, introduced measures aimed at ensuring the state's participation.
And Medicaid expansion supporters rallied at the Capitol the day after Fallin's State of the State address to urge that she allow Oklahoma to take advantage of the federal offer to help the working poor.
"This, I thought, was a no-brainer," said Inman, especially considering the state's hospitals and health care providers currently are staggering beneath the weight of $600 million in annual uncompensated care. "Many rural hospitals are teetering on the brink."
"If it's good enough for crazy Jan Brewer, it ought to be good enough for Oklahoma," he added.
Fallin, of course, has to be careful how she proceeds. So, she declined to meet with Coalition to Expand Medicaid representatives who wanted to present her with the petitions.
It's evidently not a good thing to let the Tea Partiers think you're willing to sit down with the enemy.
But --if Florida's Scott eventually reverses course and opts in --and if Idaho's Otter does, too ... if Leavitt's report suggests the federal Medicaid expansion is the best course ... Fallin can surely make a strong case to the vast majority of Oklahomans that it's the right thing to do.
And if she does, it would further isolate her party's extremists, who are wielding far more power than their numbers suggest, primarily because too many elected officials live in fear of the next election.
Imagine that: After all the gnashing of teeth over Medicaid expansion, we could end up with good public policy and good politics.
That would be something to dance about.
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