The exquisite hypocrisy of GOP Medicaid expansion rhetoric by Stephen Stromberg

http://www.washingtonpost.com/blogs/post-partisan/wp/2015/02/27/the-exquisite-hypocrisy-of-gop-medicaid-expansion-rhetoric/

In the current fight over expanding health-care coverage to low-income people, Republican state leaders often deploy some version of this argument: States shouldn’t accept billions in federal money to expand their Medicaid programs because the debt-burdened federal government won’t keep its financial commitments. Responsible leaders shouldn’t structure their budgets on the fiction that the federal government will maintain the same level of support in the future, lest states be left with the expansion bill years down the road.

But in policy areas outside the Affordable Care Act’s Medicaid expansion, GOP state leaders don’t demonstrate the same amount of concern that a tottering federal Treasury is likely to renege on its obligations to the states. In fact, Republican state budgets suggest the opposite view.

Here’s the kicker: The states that are the most dependent on the federal trough are GOP anti-Medicaid expansion holdouts. Of the 11 states that got the highest proportion of their revenue from federal grants in 2013, 10 of them have refused to expand their Medicaid programs — even though the Affordable Care Act committed the federal Treasury to covering nearly all of the expansion costs, which means that ACA Medicaid expansion comes on better terms for the states than many other federal grant programs.

If GOP leaders believe that a “precarious,” “mortgaged” federal Treasury is so burdened by “outrageous debt” that it won’t be able to keep its end of the Medicaid expansion bargain, they should apply the same concerns to all sorts of other commitments they have accepted from the federal government. But it’s a lot more likely that Republican state leaders are willing to rest their budgets on the cornerstone of state-federal cooperation — except when that cooperation comes under the label of Obamacare.