Over at Vox, Sarah Kliff looks at the growing number of Republican governors who are expanding Medicaid under the Affordable Care Act—with conditions attached. GOP governors are negotiating with the Obama administration for waivers that allow them to give their state Medicaid programs a more conservative bent. For example, some states use Medicaid dollars to purchase private insurance for low-income individuals. Other states require enrollees to pay an increased amount of cost sharing or they restrict access to certain benefits that aren’t deemed essential.
These waivers are expanding Medicaid to millions of individuals, which is better than not expanding coverage. Some of these conservative policies, like charging premiums to individuals with extremely limited means, seem to have less to do with promoting personal responsibility than with winning the favor of far-right state legislators who possess an almost pathological animosity towards the poor. But thanks to the Supreme Court, states are not obligated to expand Medicaid and they are in a much stronger position to seek concessions from the feds.