WASHINGTON — Partisan politics are coloring governors’ decisions about whether to expand Medicaid in their states, affecting billions of dollars and thousands of low-income people.
The question of whether they receive Medicaid coverage may have little to do with need, and much to do with the way their states vote in governors’ races, including primaries.
Every Democratic governor has called for accepting larger-than-usual federal subsidies to expand Medicaid, the government health insurance program for the poor. The only three who failed were blocked by Republican state legislators.
Most of the 30 Republican governors have turned down Medicaid expansion, and the federal dollars that would come with it. Some who face potential tea party challengers in next year’s GOP primaries have rejected advice to broaden the program, which they call a costly federal overreach.
But a few Republican governors dismiss those arguments. They have accepted billions in federal money to cover more people with Medicaid. It would shortchange their constituents to do otherwise, they say, noting that workers everywhere pay the federal taxes now up for redistribution.
Bucking the trend of most Republican governors, Gov. Brian Sandoval told a newspaper editorial board, “I couldn’t sit here and defend to any of you $16 million that just went away because of ‘principle.’”
Of the eight Republican governors who will expand Medicaid, six are from states carried by President Barack Obama. One is New Mexico Gov. Susana Martinez.
“My job is not to play party politics, but to implement this law in a way that best serves New Mexico,” Martinez told state legislators.
At least 20 Republican governors have turned down the federal money and declined to expand Medicaid, although a few are considering other options. Many say government is too big already, and they suggest Congress will break the promise to keep paying a huge share of the cost.
States that decline to expand Medicaid “are forgoing billions of dollars in federal funds, while residents in their states are contributing to the cost of the expansions in other states,” said a study financed by the Commonwealth Fund, a private foundation.
Medicaid now covers 62 million people, one-fifth of all Americans.
The option to expand the program, as part of the president’s health care law, could cover millions more by extending eligibility to households earning up to 138 percent of the poverty level. That’s about $32,500 for a family of four.
The government will pay the full expansion cost for the first three years, and gradually reduce the subsidy to 90 percent. The traditional federal match for Medicaid averages 57 percent.
Some Republican governors say even a 10 percent share of expanded coverage would burden future state budgets. But others say a 9-to-1 leverage is hard to beat, and they reject the idea that the federal government won’t keep its 90 percent funding promise.