Much as they love to bad-mouth Obamacare, the country’s Republican governors are swooning over one of its key provisions―the federally funded expansion of state Medicaid programs to cover millions of people who can’t afford private health insurance. The latest state to swallow its scorn is New Jersey, where Gov. Chris Christie announced a change of heart during his Tuesday afternoon budget address. The move could bring health coverage to 300,000 New Jersey residents who currently lack any health insurance. “I am no fan of ACA [the Affordable Care Act],” he tweeted after his announcement. “[But] accepting these federal resources will provide health insurance to thousands of low-income New Jerseyans and actually save taxpayers money.”
Fiscally, Christie’s move was a no-brainer. Faced with modest revenue projections and a looming $473 million budget gap, he wasn’t in a good position to turn down billions in federal assistance to provide much-needed health care services. Until now, Medicaid has largely ignored childless adults―forcing many into hospital emergency rooms to seek free care when they’re sick or injured. But under the terms of Obama’s Medicaid expansion, adults earning less than 138% of the federal poverty level can get coverage even if they don’t have children. The expansion will take a big federal investment, but it should ultimately cut health care costs by moving indigent patients into primary-care settings, where preventive care and disease management can ward off costly health crises. The expansion will also spare hospitals the huge burden caring for people who can’t pay but can’t be turned away.
Politically, the decision involves a bit of flip-flopping. A longtime critic of health care reform, Christie recently vetoed his own legislature’s effort to create a state-run health insurance exchange. New Jerseyans will still be able to shop for affordable coverage in a federally managed exchange, but Christie is boycotting the effort. Until now, Christie has had nothing kind to say about the Medicaid expansion either. Last summer, when the Supreme Court ruled that individual states could opt out of the national expansion that Congress and the president outlined in the Affordable Care Act, Christie voiced bitter delight. “That’s a relief because Obamacare on Medicaid to the states was extortion,” he said at the time. “Essentially, [Congress and the president] said, ‘You expand your program to where we tell you, and if you don’t, we’re taking all the rest of your money away.’ Well, that’s extortion! It was in a whole bunch of nice words in a bill, but it was extortion.”
Christie is in good company as he changes his tune. Seven other Republican governors, including such die-hard Obama foes as Jan Brewer of Arizona and Rick Scott of Florida, have made the same move since the start of the year. As Scott conceded when he joined the trend last week, “I cannot, in good conscience, deny the uninsured access to care”―not when the feds are paying the cost anyway. With today’s announcement, Christie brings to 27 the number of states committed to expanding Medicaid through Obamacare. Seventeen, all led by Republican governors, have declined. Six are still undecided. Christie’s decision may not win him friends at CPAC, which is denying him a speaking role at its annual meeting, but his own constituents may take a brighter view. “The decision to accept federal funds to expand health coverage will not only help balance the state budget,” Dena Mottola Jaborska of the watchdog group New Jersey Citizen Action told the New Jersey Star-Ledger. “It will save lives.” That was as true a year ago as it is today, but Christie deserves credit for seizing the chance while he has it.
Read more about Obamacare and the countdown to 2014, and look at your own state’s health ranking.
Geoffrey Cowley