Irony, thy name is Republican. The President of the Sovereign Republic of Texas, I mean Texas governor Rick Perry - who has beat his chest and stomped his feet against Obamacare to no end - is now putting his tail between his legs and his hat in hand begging the Obama administration for $100 million of that Obamcare pie - to improve and expand Medicaid services for the elderly and the disabled in the state. As Politico reported yesterday,
Gov. Rick Perry wants to kill Obamacare dead, but Texas health officials are in talks with the Obama administration about accepting an estimated $100 million available through the health law to care for the elderly and disabled, POLITICO has learned.So, Rick Perry doesn't want to expand Medicaid under Obamacare, but he wants $100 million of it anyway to improve Medicaid services in a different way.
Perry health aides are negotiating with the Obama administration on the terms of an optional Obamacare program that would allow Texas to claim stepped-up Medicaid funding for the care of people with disabilities.
This is the danger the Republican party has created in describing Affordable Care Act in its entirety as the devil's spawn. They have succeeded somewhat, preventing the overall idea from becoming popular (although that is about to change in 2014), but by the same token they have convinced their own idiot base that touching Obamacare in any form at all is anathema for their party. Their leaders are not allowed to accept 100% federal funding for Medicaid expansion (hence Jan Brewer is now persona non grata), to form marketplaces (exchanges) - handing it over to the federal government instead, or even to seek any funding under any program that is touched by Obamacare.
Any negotiations, any claim of funds provided by Obamacare is considered making a deal with the devil. After all, their goal is to defund the law altogether; accepting funds from something they are supposed to be hell bent on defunding is therefore horrifying.
Republicans have been so strident in their opposition to health care reform that they have forbidden themselves from claiming the usual federal government dollars that their states would be eligible for. But turning down federal money means someone somewhere is going to have to pay for the care of the uninsured. The Obamacare program Perry is trying to get money for is actually expected to reduce state Medicaid expenses, given that it focuses on home health care for the elderly and disabled instead of more expensive (and often less effective) hospital care. You see, by rejecting Obamacare, Republicans would actually create more expenses in their budget, which could interfere with their unearned reputation as spending-reducers.
Rick Perry's struggle with this issue highlights the broader Republican dilemma with Obamacare and the reason some are desperate to defund it at the eleventh hour: the Republicans in positions of power know that the Affordable Care Act will work. They know that when it comes into full effect next year, it will show the differences in uncompensated medical costs for hospitals in states that accept the Medicaid expansion vs. the ones that refuse it. They know that people will be galvanized over this issue, and this time, they will be aided by the hospital industry that does not want to have to provide uncompensated care. They know that their ideological interests (the Tea Party) will be aligned against their financial interests (the health care industry).
They know that if they continue to wholesale reject health reform while it begins to work - and work better in states that fully accept and implement it - on a large scale, they will be scorned by people who are being denied benefits they could otherwise get, forced to fund uncompensated care from state coffers, and be abandoned by their financial benefactors in the health care industry who are looking for a piece of the pie of Obamacare's funding. If they drop their opposition, they will be seen as weak, unprincipled and compromised by their own base. Either way, it would threaten their ability to stay in power.
And so, their only hope is to try to make sure that the law can't be implemented as scheduled. In their minds, if it can't be implemented, then the pressure its implementation would create on GOP state houses to wholesale surrender will also dissipate. They want to keep millions of people from getting health care because if they do, the Republican power structure will be exposed for an emperor with no clothes.
Do I feel bad for them? Not one bit. I'm giddy. I have long said that Obamacare will be a major factor in robbing Republicans of their political power in 2014, and I am only getting more and more sure of it.