Why are Republican governors giving in and embracing the Medicaid expansion created by the Patient Protection and Affordable Care Act? The answer is obvious: money!
It all comes down to dollar signs. If states choose to expand Medicaid, the federal government will cover 100 percent of the costs from 2014 to 2016. The feds' contribution will begin to decrease in 2017, but will never be less than 90 percent, under the ACA.
"For many states, it's going to be very difficult for them to leave that money on the table," Linda Blumberg, a health economist and senior fellow at the Urban Institute, told Governing on June 28, the day of the Supreme Court ruling. "I think there is going to be considerable financial pressure -- both from providers and the reality of state budgets -- to go with this" [Dylan Scott, "Why GOP Governors Are Coming Around on the Medicaid Expansion," Governing, 2013.01.16].
The same thing happened, says Scott, with Medicaid in 1965:
In the program's first year, only about half of the states signed on. But within a few years, 49 had come onboard (Arizona was the last to join in 1982). Political will gave way to fiscal realities.
"They all did the math and had to ask, 'Why am I leaving all this money on the table?'" [George Mason University health policy prof Len] Nichols told Governing. It’s a deal that most states will not be able to refuse in the long run. That’s why the administration is acting confident that all states will come in" [Scott, 2013.01.16].
Nichols says math usually trumps ideology. Scott says even GOP ideologues Rick Perry, Scott Walker, and John Kasich appear to be hedging their ObamaCare resistance in favor of the same welfare-state philosophy that keeps South Dakota afloat.
Expect Governor Daugaard to say yes to the Medicaid expansion by the end of his first term. And expect me to say, "Thank you, Dennis"... and "I told you so."