Republicans who oppose Obamacare could deny millions of low-income people insurance

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Still opposed to President Obama’s health care law, a growing number of Republican governors are declaring they will reject federal funds for Medicaid that they could receive next year, putting almost 5 million low-income Americans in danger of not getting health insurance.

Pennsylvania Gov. Tom Corbett this week joined 10 of his GOP colleagues in saying he would not accept new federal money for Medicaid, which was intended by Obama to be expanded next year to almost every American family earning less than $32,000 and individuals with income below $16,000.

“Obamacare” originally required states to expand their Medicaid programs in 2014 as set out under the law or lose all federal funding for Medicaid, but a U.S. Supreme Court ruling last year which upheld the overall health care law struck down the Medicaid provision. States can now choose whether they want to expand Medicaid further, but will not lose their existing Medicaid funding.

Corbett and other Republicans say they are rejecting the Medicaid funds on the grounds that it would still be too expensive for their states, as the Pennsylvania governor said the program was on an “unsustainable path.” This is a questionable claim. Under the law, the federal government would pay 100 percent of the cost for new Medicaid recipients from 2014-2016, then pick up about 90 percent of the tab after that.

But the Republican governors say they fear the federal government could eventually reduce that number far below 90 percent, costing their states billions, even as Obama administration aides have emphasized the healthcare expansion is not a “bait and switch.”

In truth, cost is not the only reason Republican governors are rejecting the funds. Many of them, like Louisiana’s Bobby Jindal, have long been ideologically opposed to Medicaid because it is a massive government-operated health insurance program. And conservative activists, still angry about the law, are putting heavy pressure on Republican governors to stop the Medicaid provisions and at least weaken “Obamacare.”

When Ohio Gov. John Kasich, also a Republican, declared this week he would accept the new Medicaid funding, the conservative National Review blasted him in an editorial.

About 4.7 low-income million Americans who would be newly eligible for Medicaid in 2014 live in the states where Republican governors have already declared they will not accept the new funding. (Along with Pennsylvania, the others are Alabama, Georgia, Idaho, Louisiana, Maine, Mississippi, Oklahoma, South Carolina, South Dakota and Texas, according to the Advisory Board Company, which is tracking the Medicaid program. The Kaiser Family Foundation last year broke down Medicaid eligibility by state.) And millions more live in GOP-controlled states where governors have not yet said if they will accept the Medicaid funding and are under political pressure not to.

The issue is not completely divided on partisan lines. Five states run by Republicans, including Ohio, have chosen to expand their Medicaid programs, and a few states with Democratic governors are considering not accepting the funds.

This debate is not just political. People who have health insurance tend to go to the doctor more regularly, not waiting until a problem persists and then hurrying to an emergency room. A lack of health insurance and then getting an illness that requires huge medical costs is also one of the leading causes of people going bankrupt.

At the same time, as conservatives warn, people with health insurance tend to use more medical services, potentially driving up how much the U.S. government spends on health care.

Follow Perry Bacon Jr. on Twitter at @PerryBaconJr.