With the GOP convention about to kick off in Cleveland, the nation’s political spotlight is trained squarely on the Republican Party. Voters across the country are watching it decide where to stand on key issues, notably healthcare.
But as the debate over the direction of the party continues, national Republican leaders must ratify a platform that its entire base — not just the national leadership — can rally behind.
Republicans’ official platform will almost certainly mention healthcare reform, specifically where the party stands on the expansion of Medicaid. But even in states where state leaders and voters support Medicaid expansion, national leaders continue to block it. U.S. Sen. John Thune of South Dakota voted to repeal the Affordable Care Act and its expansion of Medicaid even though 74 percent of South Dakotans and Republican Gov. Dennis Daugaard support expansion.
Unless the GOP can remedy the disconnect on Medicaid expansion in its platform to be ratified during the convention, the party could miss a crucial opportunity to broaden its appeal come November.
Why States Leaders Are Bucking GOP Orthodoxy
The GOP divide on expansion reaches far beyond Thune and South Dakota. Although national GOP legislators remain adamantly opposed, Republican governors in Utah, Michigan, Ohio, New Jersey, Indiana, and Wyoming — as well as Republican-controlled legislatures in Georgia and elsewhere — are agitating for expansion.
Expansion is popular among state leaders because they’ve seen its impact on public health, state budgets, and rural healthcare access. Since the ACA’s inception, 52 of the 68 rural hospital closures — more than 75 percent — have been in non-expansion states. These hospitals are struggling to stay open because they’re burdened by higher levels of unrecoverable debt and charity care than peers in expansion states.
To encourage states to adopt the hospital-saving program, the federal government has incentivized expansion. Through 2016, states can expand Medicaid entirely with federal money — a far better deal for states than the 50-50 split between federal and state dollars historically used to fund the program. In terms of federal funding, that amounts to billions of dollars per state in additional revenue.
Those funds are a big reason why state GOP leaders have embraced expansion, and they put national Republicans opposed to expansion in a difficult position with voters and the party’s core values.
National Republicans Must Come Aboard
While federal Republicans hold great sway over the party’s decisions in primary season, the power balance shifts during the months prior to the general election. The country is less than four months away from choosing the next president, and the GOP needs to start notching points with voters if it wants to stay in the game.
Eating its pride to support expansion is a perfect way for the GOP to drive up the score. Conservative governors who support expansion perform an average of 8.5 percentage points better with voters, implying a conservative presidential candidate could benefit, too. Even in GOP-heavy states, poll after poll shows overwhelming support for expansion. In Utah, nearly three-quarters of voters support it, as do majorities in conservative Kentucky and Mississippi.
With quite possibly the most divisive candidate in history set to receive its nomination, the Republican Party can’t afford to deny voters and state leaders what they want any longer.
Every day it continues to speak out against expansion, the GOP encourages voters to defect to Hillary Clinton, and popular Republicans like Govs. Chris Christie and John Kasich have proven it’s possible for conservatives to survive an about-face on expansion.
If Republicans won’t give voters what they want, then they shouldn’t expect voters to return the favor.
Benjamin Geyerhahn is founder and CEO of BeneStream. A recognized leader at the convergence of health care and social impact business, Ben is also a member of the Advisory Board of Maxwell Health and a contributor to Forbes and Skoll World Forum.