John Colson: Will Medicaid expansion defy Trumpian tactics?
November 26, 2018
There has been considerable debate about the Affordable Care Act's expansion of Medicaid, which reportedly has been put in effect in some 30 states since the ACA was enacted in 2010, and how the administration of President Donald J. Trump has reacted to that programatic expansion since his election two years ago.
As is widely known, Trump and his Republican supporters have done everything they could to hobble the ACA, despite the health care law's growing popularity among voters.
It started with the unsuccessful attempts to entirely scuttle former President Barack Obama's signature health care reform and continued with efforts to undo as many components of the ACA as possible in the wake of the failed congressional "repeal and replace" stratagems of 2017.
The expansion of Medicaid has been a critical part of the ACA's intent to provide health insurance to previously uninsured segments of the populace, because health insurance (or, more precisely, the lack of it) had left vast numbers of people without adequate health care.
Earlier this year, there was a push to boost the expansion of Medicaid across the nation, including efforts by some in the Trump administration to at least partially expand Medicaid as a way of staving off a larger and less welcome expansion of services to the poor and marginalized portions of the population. That larger expansion due to the ACA's regulations was viewed as inevitable if things stayed as they were, even in states that had been following Trump's lead in refusing to accept expansion for whatever reasons.
Here in Colorado, of course, Democrat Gov. John Hickenlooper in 2014 accepted the federal funding that came with expansion of Medicaid, and Medicaid enrollment has been steadily on the rise ever since.
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Even in Ohio, which was one of the states that unexpectedly gave the presidency to Trump in 2016, Republican Gov. John Kasich (an opponent of Trump's in the primaries and a frequent critic of Trump since) went along with the Medicaid expansion. And that single act has been credited with doing more than just about anything else to tamp down Ohio's well-publicized and quite monstrous problems with opioid addiction and overdoses.
Thus, we have the odd juxtaposition of Trump's hostility toward the ACA and the expansion of Medicaid, versus Kasich's embrace of Medicaid expansion to grapple with an issue that Trump claimed as a key political issue in his presidential campaign — the opioid epidemic.
Given that dichotomy, it was puzzling last July when Trump decided to derail all discussions of a national, partial national expansion of Medicaid, which his advisers saw as a wise political strategy to prevent an even broader expansion by voters or statehouse politicians.
The president, hoping for a HUGE electoral win in the mid-term elections, put off the talks on Medicaid expansion until after the elections were over, choosing instead to focus his attention and his bluster on the non-crisis of the "invasion" of the southern U.S. border by a group of desperate refugees from Central America.
It was a cynical political ploy, and one that obviously did not work, since the voters overwhelmingly handed control of the House of Representatives to Democrats on Nov. 6, and at the same time approved Medicaid expansion in states that once had rejected that very idea.
In Utah, for instance, the governor tried to defuse pressure from voters and approved new laws enabling the very limited expansion that Trump tried to stop. But voters went ahead and approved a broader expansion anyway, which will bring full Medicaid expansion to the state.
Nationally, according to exit polls on Election Day, health care was the top issue of concern to most voters, ahead of the economy, immigration and gun control.
This all leaves Trump with limited options regarding the expansion of Medicaid and the fate of the ACA overall, in the eyes of many observers, who believe that Trump shot himself and his party in the foot last July and that he may have set the party up for another bad outcome on election day 2020.
What's a president to do?
Nobody knows, but Trump seems determined to continue with his tendency to divert, deflect and defuse (the three-D strategy) voter displeasure regarding his fight to kill the ACA.
Interestingly, when his three-D strategy of demonizing the immigrant caravan failed to ignite an anti-Democrat backlash, he has pretty much dropped the issue entirely. You don't hear much these days about the approach of an invading horde from the south, at least not from Trump.
Of course, Trump now has a new diversionary ploy — threatening to shut down the government while Republicans still have control of the house (the big flip to Democratic control happens in early January) if Congress does not provide funding for his much-ballyhooed wall at the Mexican border.
That seems like another non-starter and a political mistake, in my view, but like all fast-moving sporting events, the shifting tide of politics in the U.S. is impossible to predict.
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