Corbett sees the light on Medicaid

The issue of Medicaid expansion has divided Republican governors in a fascinating way. On the one hand we have eight GOP state chief executives who’ve run the numbers, listened to state health experts, looked at their state budgets, and accepted the fact that the policy is a no-brainer.

On the other hand, we have the other 22 Republican governors. Some seem to be bad at math, some want to run for national office and don’t want to be seen adopting a major provision of the Affordable Care Act, and some are purposefully willing to undermine their states to spite President Obama.

Earlier this year, Pennsylvania Gov. Tom Corbett (R) was in this second group. Though Medicaid expansion would bring coverage to about a half-million uninsured people in the state, the governor announced in February he would reject the policy.

That was seven months ago. Corbett has apparently reconsidered.

As early as Monday, Gov. Tom Corbett will propose a plan to expand Medicaid coverage to more poor adults as part of the federal Affordable Care Act. […]

Earlier this year, Corbett rejected the expansion of Medicaid under Obamacare. But he has continued a dialogue with the Obama administration via meetings and letters, though with no formal proposals.

At the top of Corbett’s option list now is a Medicaid expansion program akin to those being considered in Iowa and Arkansas.

If you want to brush up on the details of what makes this approach different, we covered the story in April.

Regardless, if these reports are accurate and Corbett is now prepared to expand Medicaid — a decision he can apparently make without the legislature’s input, though he’d need the Obama administration’s approval — it’d be a significant breakthrough for reducing the number of Americans without coverage.

As for why the governor changed direction on this issue, we can make some educated guesses.

Josh Barro had a good piece on this.

Corbett, like other Republican governors, is in a tough position. Conservatives are obsessed with blocking Obamacare and they don’t want states to participate in any way, even if the federal government will pay substantially all the costs. But when Republican state officials decline to participate, they will have to explain to both medical providers and potential Medicaid beneficiaries that they turned down free federal money just to spite the president.

The hospital situation will become especially untenable in 2014. The federal government will cut so-called “disproportionate share” payments to hospitals that are meant to compensate them for treating the uninsured, because the Medicaid expansion should reduce the number of uninsured patients. Without added Medicaid payments to offset the reduced disproportionate share payments, some hospitals will close. And Medicaid-blocking Republicans will take the blame. […]

Corbett, who faces his own uphill battle for re-election, seems to understand that he can’t afford to take the blame for needless hospital closures next year.

This isn’t an abstract risk. Just last week, a North Carolina hospital announced it will have no choice but to permanently close its doors as a result of Gov. Pat McCrory’s (R) decision not to expand Medicaid.

It now appears Corbett won’t have to deal with this problem in Pennsylvania. What’s more, given his poll numbers, it won’t hurt that he won’t have to explain why he turned down federal funds on purpose to deny coverage to hundreds of thousands of his constituents.