Path to Republican Victory on Health Care
When it comes to Medicaid, Republicans need to find something to be “for”
This past election cycle, Republicans across the country took a major hit at the ballot box. One of the main reasons is because they are quite skilled at saying what they are “against,” but are often challenged in articulating what they are “for.” Republicans should take this lesson from 2012 and apply it to the elections beyond.
We must face the reality that Republicans can no longer afford to simply be against things – we can’t afford to do nothing and hope for the best.
That is why we are seeing a trend of Republican governors moving past the fights on 2012 and implementing the Medicaid expansion. Governors Brewer, Martinez, Sandoval, Kasich, and now even Florida Rick Governor Scott have followed suit. Their decisions are about more than just more money for their state – it’s about realizing that Republicans need to find a way both to claim victory on health care and to deliver better health care to the citizens of this country that they have now.
Law of the land
Elections have consequences. From its start as legislation all the way to its ultimate challenge at the Supreme Court, many of these Republican Governors were front and center in fighting Obamacare. The Supreme Court upheld the law and Obama was re-elected as President. The Affordable Care Act is the law of the land and it will stay that way for the time being.
Simply ignoring it or continuing to rail against it does nothing fix the problem of run away federal spending. Being the party of “No” does nothing to impact real change or promote reform – see the 2012 elections results for yourself.
Costs to the state
Those who are in desperate need of health care are just going to show up in our emergency rooms, where our system delivers the most expensive form of care. Doing nothing is tantamount to cutting your nose off to spite your face. Such a platform is not the path to victory for Republicans.
Uncompensated care provided by safety net hospitals has nearly doubled as a result of the great recession and the freeze on AHCCCS enrollment. The increasing uncompensated care costs cannot continue without seriously jeopardizing the medical services that these hospitals provide to patients throughout Arizona. Smaller, rural communities are particularly vulnerable.
Respecting the will of the voters
Republicans were elected by the voters and need to respect their will in all situations, not just the ones that are convenient to them. Arizona has an obligation to restore AHCCCS coverage for poor childless adults because that health care coverage was approved by the voters in 2000 with 62% of the vote.
The courts supported the cutting of childless adults when the state was out of money, but it’s only a matter of time before the challenge is raised again. While the General Fund is not awash in receipts, the fiscal outlook for the State has improved markedly since enrollment was closed for childless adults in July of 2011. FY 2012 closed with an ending balance of $400 million - $275 million higher than budget; there is $450 million in the Rainy Day Fund; and it appears that caseloads and spending at AHCCCS are moderating while the economy is improving. With these resources, and the bag of money the Affordable Health Care Act leaves on Arizona’s doorstep, the funds are available to restore health care coverage for this population. Republicans shouldn’t give the courts and the electorate another opportunity to kick us in our gym shorts, and we should not send Arizona’s share of the federal money to a state that will waste it.
Promoting real reform
Republicans can’t allow a perpetual obstructionist attitude to stand in the way of real reform. Indeed smaller government is desirable, but it will never be enough for those who would rather see no government at all. The problem is, and voter survey after voter survey demonstrates, that a majority of citizens believe that there are core functions that the State government should perform – education, public safety, transportation, and even helping those in need.
When it comes to health care spending, Arizona is not the problem, it is the solution. Instead of Republicans being against Governor Brewer’s decision, they should be for more states following Arizona’s lead and demanding real reform. Arizona is the model that the other states should follow to help decrease costs, increase efficiencies, and provide more choice. Arizona pays for health care for the poor based on the number of patients cared for (called capitation funding) and not the number of expensive procedures performed (called fee for service funding). In 2009, the average cost for an Arizona enrollee per year was $4,846. The top ten states were Pennsylvania, Massachusetts, North Dakota, Minnesota, New Jersey, Rhode Island, Alaska, New York, District of Columbia, and Connecticut. Their average cost ranged from $7,397 to $9,577. That’s between 53% and 98% higher than AHCCCS.
If Republicans want to take aim at someone, they should target states like Connecticut or New York. A significantly larger amount of federal and even health care dollars could be saved by these states adopting the innovations and cost containment policies of AHCCCS than would be saved by Arizona refusing enhanced federal dollars.
Looking to 2014 and beyond
There are some who believe that Arizona is already becoming more of a blue state. If Republicans - stand pat as the party of “NO,” the blue state fans will likely be right. If Arizona Republicans don’t find a way to restore the voter mandated Medicaid funding, between 50,000 and 60,000 people will be kicked off of the health care program (including cancer patients mid treatment) 11 months before the next gubernatorial General Election and a week after Christmas 2013. If Republican leaders are going to let that happen, they might as well accept that the Governor’s office and several other statewide offices are going to change parties in 2014. Nearly 60,000 patients out on the street will make the medical transplant suspension of 2010 look like a walk in the park.
A recent survey shows that a large majority of Independents and half of Republican women support restoration and expansion of the Medicaid program. While true that older Republican men still dislike all things Obamacare, they are not enough to win a General Election. A plan for health care will be critical to maintaining critical Republican women and swing Independent voters in tough general election contests against Democrats. Democrats are all in supporting health care and it could be a critical wedge issue to help them co-opt independent voters to bolster support in competitive statewide and district races. Competitive district Republicans will need to offer more than a “no” vote.
Problems demand solutions
When it comes to Medicaid, Republicans need to find something to be “for.” Governor Brewer’s plan offers a reasonable approach with a “circuit breaker” that takes the state off the hook if the Federal Government fails to uphold its end of the bargain.
Republicans have a chance to restore health care to those in need and then use this opportunity to position the state as a leader in cutting costs in a real way – reducing the federal deficit and putting us on the path towards fiscally responsible and sustainable government programs. Otherwise, Republicans will continue to fight the fights we have already lost and devolve into an entrenched party of “NO.”
GOP leaders need to navigate through these tough times and continue to support our base voters sentiments while adopting good government positions that shrink the size of our government, utilize the private sector to a greater degree and put our public programs on a more fiscally sound footing. Clearly this President either doesn’t care or know how to do the very things that a majority of voters want; cost effective, efficient, stabilized government that supports core government services.
Ronald Reagan, as a practical conservative, understood all of these things and was willing to fight for them. We need more Republicans like him and Jan Brewer in order for our Party to succeed.
Republicans who want to maintain a governing majority in Arizona would be wise to join this Governor in supporting her plan to restore and expand the AHCCCS populations in Arizona. Her leadership led this state to overwhelming victories in the 2010 cycle; 2/3 majorities in both Houses of the Legislature and a sweep of every statewide office.
No one has a better plan and a better track record than this Governor. Follow her and our Party will prosper, don’t and we won’t.