Medicaid Expansion States Home to GOP Healthcare Defectors? By Luke Perry

Medicaid Expansion States Home to GOP Healthcare Defectors? By Luke Perry

Twenty GOP Senators (listed below) represent states that expanded Medicaid under The Affordable Care Act (ACA or Obamacare). The newly proposed Senate bill seeks to defund federal support that made this expansion possible. Existing subsidies cover people who make up to 138 percent over the poverty line, including people who work full time or several part time jobs, but don’t have benefits and cannot afford health insurance.

Repealing this element of Obamacare creates policy and political problems for Republicans. It's a main reason why tens of millions of people are expected to lose coverage if the American Healthcare Act becomes law. Senators who reside in expansion states, and support repeal, risk facing major political backlash.

Six expansion states are represented by two Republican Senators. Of these six, Arkansas and Iowa can likely be counted on to support the bill. Arizona, Alaska, Kentucky, and Louisiana may be home to some of the few opponents needed to break the current 52 vote Republican majority in the Senate.

In Arizona, Jeff Flake is one of just two Senators of the twenty who are up for reelection. Dean Heller (NV) is the other. Both are considered highly vulnerable heading into the midterms.

Heller faced scrutiny immediately after the 2016 election as the only GOP Senator subsequently facing reelection in a state Hillary Clinton won. His situation has worsened with a seven point drop in the polls and a formidable Democratic challenger now in place. Flake was similarly deemed vulnerable after the 2016 election, but for different reasons. He never embraced Donald Trump, prompting a primary challenge now underway.

In Alaska, Lisa Murkowski has been critical of the Senate process for creating the bill, having claimed to not see an advance copy because she’s not a reporter or lobbyist. Murkowski also stated she won’t vote to defund Planned Parenthood, which the bill does for one year.

In Louisiana, Bill Cassidy has stated the Senate bill should pass the “Jimmy Kimmel Test,” in reference to Kimmel’s passionate monologue, inspired by his son, regarding coverage for people with preexisting conditions. Others have similarly expressed concerns about going too far in repealing the ACA, including Shelley Moore Capito (WV), Cory Gardner (CO), and Rob Portman (OH).  

In Kentucky, Rand Paul has been a steady critic of Obamacare repeal efforts and was among the first GOP Senators to oppose the Senate bill. This makes him an usual counterpart to Mitch McConnell, who originally expressed skepticism about having the votes. This makes one wonder if he put forth this current bill to vote it down, so the Republicans can move forward with tax policy (Senate can only use reconciliation on one issue at a time). McConnell’s recent behavior suggests he is doing all he can to promote passage either way.

The Medicaid expansion dilemma for these twenty GOP Senators is an important reminder that policy drives politics, not just the other way around. While most Americans don’t care and aren’t well informed about American national government, “people start to care when it hits them in the pocketbook” as one local Republican leader recently put it to me.


20 Republican Senators from States that expanded Medicaid under ACA

Lisa Murkowski (R-AK)

Dan Sullivan (R-AK)

Jeff Flake (R-AZ)

John McCain (R-AZ)

John Boozman (R-AR)

Tom Cotton (R-AR)

Cory Gardner (R-CO)

Todd Young (R-IN)

Joni Ernst (R-IA)

Chuck Grassley (R-IA)

Mitch McConnell (R-KY)

Rand Paul (R-KY)

Bill Cassidy (R-LA)

John Kennedy (R-LA)

Steve Daines (R-MT)

Dean Heller (R-NV)

John Hoeven (R-ND)

Rob Portman (R-OH)

Pat Toomey (R-PA)

Shelley Moore Capito (R-WV)


Luke Perry (@PolSciLukePerry) is Professor of Government at Utica College. His column Sound Off! critiques various aspects of American politics.



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