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Even playing the Reagan Card won't help

Ohio Gov. John Kasich (R)
Ohio Gov. John Kasich (R)Associated Press

Ohio Gov. John Kasich is one of eight Republican governors eager to support Medicaid expansion, even though it means implementing the Affordable Care Act. And like many other GOP chief executives, he's running into resistance from state lawmakers in his own party -- Republicans have been told to combat "Obamacare," even when that doesn't make sense.

To that end, Kasich is resorting to the only argument he has left: asking his party to consider what Reagan would do.

Leaders in the states that have decided against expanding have often invoked Reagan conservatism as the reason to oppose extending Medicaid health care coverage to more people. After all, doesn't Reagan embody modern conservatism? He cut taxes, cut government red tape and fought the growth of entitlements.

Yes, he did all those things. However, he also expanded Medicaid, not just once but several times.

For example, in 1986, President Reagan let states add poor children and pregnant women to Medicaid. And after learning that disabled children could receive Medicaid care only in hospitals and nursing homes, he let states provide them care at home also. Ohio resisted both expansions for a decade but saw powerful results for some of our most vulnerable citizens once we made them.

Kasich happens to be correct about Reagan, but it just doesn't seem to matter. Republican state lawmakers in Ohio, Arizona, Michigan, and Florida have heard pleas from governors of their own party, urging them to do the right thing on Medicaid expansion, but they're choosing not to listen -- even if that means ignoring the Reagan legacy. The Washington Postreported this morning that the intra-party fissures on this issue "continue to deepen," with ongoing battles "showing just how bitter the divisions have become."

We're probably past the point at which arithmetic is persuasive, or even relevant, in the larger discussion, but just yesterday, proponents of state-based Medicaid expansion got a major boost with a new report on just how much money these Republican state legislators are prepared to leave on the table.

The scope of this financial obstinacy is nothing short of remarkable.

States that refuse to expand Medicaid under President Barack Obama's health care reform law not only will deny health coverage to poor residents and lose access to a huge influx of federal dollars, they also will see increased spending on uninsured people's unpaid medical bills, according to a new report by the Rand Corp., a consulting firm.

The Rand Corp. analyzed 14 states with governors who oppose the Medicaid expansion. It found their actions will deprive 3.6 million people of health coverage under Obamacare, forgo $8.4 billion in federal funding, and cost them $1 billion for programs that partially compensate medical providers who care for the indigent, according to the report published in the journal "Health Affairs." Since nearly half of states may not undertake the Medicaid expansion next year, those figures could be even higher.

When a party's elected officials are willing to take this kind of hit, on purpose, just because they really hate the president, they've let partisanship override good judgment to a remarkable degree.

For many years, Medicare had a "doughnut hole" in which many middle-income seniors got hit with higher prescription drug prices. It was a problem that Obamacare, thankfully, fixed in 2010, but now we're faced with a different health care "hole" -- low-income families who will go without coverage because they live in a red state with state lawmakers who care more about politics than math.

Ed Kilgore calls this the "wingnut hole," which is as good a name as any.