Standing In The Way Of History Is Often Fatal-- As Both Republicans And Conservative Democrats Are About To Find Out

The Republican Party, particularly the congressional wing, has one issue they're gearing up for the midterms: Obamacare. After doing everything in their power to sabotage it, from inception to roll out, the, Republicans want to focus all their attention on howling about what a failure it is. But are people buying their message? Over the weekend we saw how a Republican primary in northeast Louisiana resulted in a loss for the Establishment, party-line candidate and a win for a candidate who ran explicitly on expanding Medicaid for working families. That doesn't fit the GOP narrative for R+15 districts. Vance McAllister went into the runoff as the clear underdog… and won with 60% of the vote. Unlike his opponent, he did not follow the GOP line on healthcare.

While some thought the all-Republican runoff would be marked by each candidate running to the far right of every issue, McAllister took leave of the usual party line during a debate last week by coming out in support of optional Medicaid expansion offered under the Affordable Care Act.

McAllister said he disagreed with Gov. Bobby Jindal's decision not to accept the expansion because of the economic make-up of the 5th District.

According to census data, the district is one of the poorest in the nation with nearly 25 percent of its more than 750,000 people living below the poverty line in 2010 and 21 percent without health insurance.

Riser blasted McAllister for the admission, issuing an ad stating "a vote for Vance McAllister is a vote for Obamacare." He also claimed McAllister flip-flopped on the issue by telling Democrats he supported the health care law and Republicans that he did not.

Campaign manager Josh Robinson said he thought Riser's negative ads were one reason his candidate won, adding his team ran "ran a different campaign than we think you're going to see run across the country this year."

"We built a broad base coalition," Robinson said, thanking Holloway, Democratic Monroe Mayor Jamie Mayo and the crew from Duck Commander for their support. "It's not about ideology; it's about getting behind the right person."

McAllister refused to go negative during the campaign, saying Saturday he was proud he "never once went to the dirty side of politics."

U.S. Sen. Mary Landrieu, D-La., welcomed McAllister to the state's congressional delegation in a statement Saturday, saying she was heartened that he "emphasize that he wants to find solutions and common ground."

Perhaps you saw the joint op-ed in Sunday's Washington Post by Governors Jay Inslee (D-WA), Steve Beshear (D-KY) and Dan Malloy (D-CT), How We Got Obamacare To Work. “Obamacare,” they wrote, "is working. Tens of thousands of our residents have enrolled in affordable health-care coverage. Many of them could not get insurance before the law was enacted… It's not about our websites." That doesn't fit the GOP narrative either.

The Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football.

In Washington, the legislature authorized Medicaid expansion with overwhelmingly bipartisan votes in the House and Senate this summer because legislators understood that it could help create more than 10,000 jobs, save more than $300 million for the state in the first 18 months, and, most important, provide several hundred thousand uninsured Washingtonians with health coverage.

In Kentucky, two independent studies showed that the Bluegrass State couldn’t afford not to expand Medicaid. Expansion offered huge savings in the state budget and is expected to create 17,000 jobs.

In Connecticut, more than 50 percent of enrollment in the state exchange, Access Health CT, is for private health insurance. The Connecticut exchange has a customer satisfaction level of 96.5 percent, according to a survey of users in October, with more than 82 percent of enrollees either “extremely likely” or “very likely” to recommend the exchange to a colleague or friend.

In our states, elected leaders have decided to put people, not politics, first… What we all agree with completely, though, is the president’s insistence that our country cannot go back to the dark days before health-care reform, when people were regularly dropped from coverage, and those with “bare bones” plans ended up in medical bankruptcy when serious illness struck, many times because their insurance didn’t cover much of anything.

Thanks to health-care reform and the robust exchanges in our states, people are getting better coverage at a better price.

…We urge Congress to get out of the way and to support efforts to make health-care reform work for everyone. We urge our fellow governors, most especially those in states that refused to expand Medicaid, to make health-care reform work for their people too.

At the same time, the NY Times was publishing a very different, but not unrelated kind of story. This was about the kind of intense pressure Governor Bill Haslam (R-TN) was facing for not expanding Medicaid in his very red state. In LA-05 last year, Obama only managed to draw 38% of the voters, almost the exact same percentage he drew in Tennessee. Haslam is stuck in an untenable position… and he's one of the only governors in the country who hasn't made a decision and he's up for reelection next year. He's very popular but most Tenneeseans want the expansion and it's being pushed by the Tennessee Hospital Association and other medical groups, the Tennessee Chamber of Commerce and Industry and local chambers across the state, several antipoverty organizations and the Democratic opposition.

Rick Perry of Texas and Bobby Jindal of Louisiana, among many other Republican governors, have flatly rejected the expansion, even though it would provide billions of federal dollars to their states. Gov. Jan Brewer of Arizona and Gov. Rick Snyder of Michigan are among a small number who decided to accept it, coming under intense criticism from conservatives as a result. Gov. John R. Kasich had to do an end run around his own Republican-controlled Legislature to make it happen in Ohio.

But Mr. Haslam, who had once promised a decision by summer’s end, is still trying to negotiate a new plan of his own with federal officials, hoping it will satisfy the competing constituencies. It would involve using federal money to place many of the state’s poor on the federal health care exchange created by the act, rather than on Medicaid. But so far he has not persuaded federal officials, who have asked for more details, and said he expected no quick resolution.

Although he is not required to do so, Mr. Haslam has also promised not to enact anything without the approval of the Legislature, whose Republican majority, he said, was dead set against an expansion of Medicaid. Support for his alternative plan seems uncertain at best.

“We don’t want to expand a system that’s not doing a good job controlling costs,” the governor said, karate-chopping the air during an interview in his modest Statehouse office. “We want to end up with something that’s not just Medicaid with lipstick on it.”

Though Mr. Haslam has said he felt under no time pressure, the state faces a Jan. 1 deadline to qualify for the first $300 million in Medicaid money for the coming year. The Tennessee Hospital Association, the state Chamber of Commerce and Democrats say Mr. Haslam cannot afford to wait much longer.

The National Conference of State Legislatures says that as of this month, 21 states, all of them with Republican governors or Republican-dominated legislatures, have announced that they would not expand Medicaid, while 27 others, plus the District of Columbia, have already approved an expansion or indicated that they would do so. The election this month of Terry McAuliffe, a Democrat and a supporter of the health care act, as governor of Virginia makes it likely that the state will join the expanders.

That leaves just Tennessee and Pennsylvania, where Gov. Tom Corbett has also asked the Obama administration for permission to use federal funds to buy private health insurance for the uninsured poor, on the fence.

A son of the Knoxville, Tenn., founder of Pilot Flying J, the nation’s largest chain of truck stops and travel centers, Mr. Haslam remains a popular figure in his state. A May poll by Vanderbilt University’s Center for the Study of Democratic Institutions showed him with a 63 percent approval rating. The same poll, however, found that 60 percent of respondents favored the expansion of Medicaid in the state.

…Recent layoffs at a few Tennessee hospitals have focused attention on their plight — and complicated Mr. Haslam’s decision.

David McClure, senior vice president for finance at the state hospital association, said that failing to expand Medicaid would have a devastating effect on the state’s 165 hospitals, leading to layoffs and the closing of some facilities.

“In every community that has a hospital, we are typically the biggest or one of the biggest employers,” Mr. McClure said. “I don’t want to be Chicken Little and say the sky is falling, but there will be some hospitals that will close.”

Since hospitals are required to treat patients who show up in their emergency rooms, whether or not they can pay, hospital officials had hoped that adding more poor people to Medicaid rolls would absorb some of those costs, Mr. McClure said.

Without an expansion of Medicaid, hundreds of thousands of Tennessee residents would fall into a gap, making too little money to get subsidized health coverage under the act and too much to qualify for Medicaid. The authors of the Affordable Care Act had assumed that states would expand their Medicaid rolls-- which they had been required to do until the Supreme Court struck down that provision-- providing coverage for these working poor families who fell into the gap.

The hospital association estimates that 400,000 Tennesseans fall into that gap. Other estimates are somewhat lower.

I suspect that opposing the Affordable Care Act isn't just going to hurt Republicans like McAllister's vanquished opponent in LA-05, but will also wipe out the House Democratic cowards who voted last week with the Republicans to hobble it with the so-called "Upton fix." My guess is that the majority of these 39 will lose next year:

• Ron Barber (New Dem-AZ)
• John Barrow (New Dem-GA)
• Ami Bera (New Dem-CA)
• Tim Bishop (NY)
• Bruce Braley (IA)
• Julia Brownley (CA)
• Cheri Bustos (IL)
• Jim Costa (Blue Dog-CA)
• Pete DeFazio (OR)
• Suzanne DelBene (New Dem-WA)
• Tammy Duckworth (IL)
• Bill Enyart (IL)
• Elizabeth Esty (New Dem-CT)
• Bill Foster (New Dem-IL)
• Pete Gallego (New Dem-TX)
• John Garamendi (CA)
• Joe Garcia (New Dem-FL)
• Ron Kind (New Dem-WI)
• Ann Kuster (New Dem-NH)
• Dave Loebsack (IA)
• Dan Maffei (New Dem-NY)
• Sean Patrick Maloney (New Dem-NY)
• Jim Matheson (Blue Dog-UT)
• Mike McIntyre (New Dem-NC)
• Jerry McNerney (CA)
• Patrick Murphy (New Dem-FL)
• Rick Nolan (MN)
• Bill Owens (New Dem-NY)
• Gary Peters (New Dem-MI)
• Scott Peters (New Dem-CA)
• Collin Peterson (Blue Dog-MN)
• Nick Rahall (WV)
• Raul Ruiz (CA)
• Brad Schneider (New Dem-IL)
• Kurt Schrader (New Dem-OR)
• Carol Shea-Porter (NH)
• Kyrsten Sinema (New Dem-AZ)
• Filemon Vela (New Dem-TX)
• Tim Walz (MN)