Obamacare’s Medicaid expansion is floundering in many states across the country. That’s the upshot of a new Politico piece that looks closely at the expansion in Republican states. Even states that have done the expansions, or were moving towards them, are now experiencing uncertainty, delays, and other impediments. Utah, for example, wants to include work requirements as a condition of expansion, but it’s not clear that it will fly. Wyoming and Montana are having trouble reaching consensus on if or how to expand. The story includes other examples, but the conclusion is telling:
Advocates are betting that politicians’ reluctance to rescind benefits that people are already getting will protect the coverage, and they point out that states were slow to adopt the original Medicaid program in the mid-1960s. But some acknowledge they had expected more states to have adopted it by now.“Experience told us that we are not going to achieve 100 percent of the states coming in overnight. It’s going to take a while,” said Ron Pollack of Families USA, which supports Obamacare. Still, he added, he would have expected the list at this point to be longer — and not in danger of getting smaller.
Read the whole thing. The Medicaid expansion is key to the entire ACA. It’s politically important for exactly the reason hinted at by the article’s conclusion: the more entrenched it becomes on the state level, the more the ACA will likely live on in some form or another. And the heart of the policy goal of the ACA itself is to expand coverage to as many Americans as possible (even if that coverage is itself pretty spotty). The debate over the ACA was supposed to be long over by now, but it persists because the root causes driving popular anxiety over health care persist: cost.And here the analogy between the political logic of the ACA and the political logic of the rest of the welfare state breaks down. The assumption that the ACA will become politically entrenched depends on the idea that it provides benefits that people won’t want to give up. That assumption may be partially true, but the ACA is not a pure cash welfare policy. It provides subsidies for people to purchase insurance only. But when they go to use that insurance, even with the subsidy, many people don’t like the experience they have. As long as health care continues to put larger financial burdens on Americans in particular and the U.S. in general, the ACA’s future will always be uneasy.What America needs, and so far lacks, is for one or both of the parties to articulate a health care vision that can actually address the root anxieties keeping the ACA debate alive.