When Democrats predict that the GOP will eventually have to embrace the Affordable Care Act, they usually start with the plight of rural hospitals. In the 25 states that have accepted the Medicaid expansion, these hospitals are taking in reimbursements when they cover the indigent who are newly covered. In the 25 states that haven't—no reimbursements. Red states (and red-run blue states like Wisconsin) first embraced the Supreme Court decision that made Medicaid expansion optional, and saved them from putting up 10 percent of the cost of a new annual entitlement. But the costs of doing nothing are burning up the plains.
How can a Republican governor fix this problem without accepting the Medicaid expansion? Ray Henry and Christina Cassidy explain: They've trying to bail out hospitals within the states. In South Carolina the state has agreed to reimburse 100 percent Medicaid spending at distressed hospitals. In Georgia the Republican charged with this year's budget is looking at a bailout worth "tens of millions of dollars." In Mississippi, Gov. Phil Bryant wants $4.4 million for a bailout, and his argument for why is interestingly Leninist:
I mean, here we would be saying to 300,000 Mississippians, "We’re going to provide Medicaid coverage to you," and then the federal government through Congress or through the Senate, would do away with or alter the Affordable Care Act, and then we have no way to pay that. We have no way to continue the coverage.
There's no chance of the ACA being repealed until, maybe, 2017 if Republicans win the presidency. Bryant's looking three years ahead, suggesting that his state (and presumably other holdout states) can help grind down the law with stopgap bailouts to poor hospitals. The alternative: embracing Obamacare.
Doesn't it feel like only six or seven days ago that House Republicans were talking about ending "bailouts" for insurers in a debt limit deal? It was. They've dropped the idea. It's better for the party if they're not seen to be turning the screws on hospitals and insurers.
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