I'm a little late to this, but Simon Maloy has a terrific explainer on how Indiana Gov. Mike Pence is making a move that infuriates conservatives. Pence, like every Republican congressman, opposed the Affordable Care Act. He gave no indication that he'd expand Medicaid, as few Republican governors has done. But as of last week, he's looking for a waiver to get ACA funds that can expand the state's existing public-private health care plan.
There are two futures in health care – government-directed health care or consumer-driven health care. Indiana has chosen consumer-driven health care and intends to give eligible Hoosiers the power to make their own health care decisions through HIP 2.0.
And it's grimly entertaining to watch Pence insist that his plan does not look anything like Obamacare—no way, no how, hey, look over there. Conservatives don't buy it. Dean Clancy, who was FreedomWorks' policy guy until he got out to avoid the debris hitting him as that group collapses, has published the definitive denunciation of the Pence move.
Medicaid’s problems are a result of its joint federal-state structure, which is truly diabolical, incentivizing politicians at all levels to expand welfare dependency while making sensible reforms well-nigh impossible.
As a result, Medicaid is now among the biggest drivers of federal and state deficits, has become the default health plan for one in five Americans, and pays for half of all US births.
Expanding that isn’t very “conservative.” Which is why conservatives like Pence try to disguise what they’re doing behind a smokescreen of “consumer-driven, market-oriented” rhetoric.
Pence has lost the Heritage Foundation, too, and there's more to this backlash than the policy. Pence was a conservative radio host who became a conservative congressman who became a conservative governor—and he's no longer on team Repeal. He compares unfavorably with Louisiana Gov. Bobby Jindal, who's term-limited out of office at the end of 2015 and is currently running around decrying the girly-men who don't think Obamacare can be repealed. "According to those in the elite salons of Washington, ObamaCare cannot be repealed," he writes in a new Fox News column. "The conventional wisdom on the cocktail circuit contends that once you mandate health insurance for millions, you cannot unmandate it."
The cocktail circuit! Elite salons! The problem is that people like Pence do not actually run that circuit, and they've noticed that the reforms of the ACA play quite well and save the state from budget crises as long as they are not referred to as "Obamacare" reforms.