It happened again last week -- Republicans in the House of Representatives failed to dismantle a key provision of the Affordable Care Act, often referred to as Obamacare. House leadership cancelled a vote at the last minute after a rebellion by conservative Republicans who "spoke out against the measure, lamenting that it merely tinkers with the law when they wanted nothing less than repeal."
But the Republican strategy to "tinker" Obamacare to death has been loudly embraced by Republicans in state legislatures, who are ignoring the advice of nonpartisan analysts, Democrats, and even many Republican governors in their zeal to deny health insurance to low income people and those with disabilities.
Blocking Medicaid expansion is the single most damaging element of the GOP strategy.
One of the best-kept secrets about Obamacare (unfortunately so, for Democrats) is that many state budgets will actually realize a net savings through Medicaid expansion, which extends eligibility to families earning up to 138 percent of the federal poverty level. This change will allow individuals earning up to $15,870 a year or a family of four earning up to $32,499 a year to have access to health insurance.
Study after study confirms the savings to states, which occur because expanding Medicaid eligibility causes the volume of "uncompensated" care -- partially paid for by state governments -- to plummet. Relieved of such responsibilities, as well as others like mental health services and prison health care, states that accept Medicaid expansion can slash billions of dollars from their budgets without denying a single dime's worth of care.
That's why so many Republican governors, including some of the most conservative in the country, have found Medicaid expansion too good to pass up. Republican governors in New Jersey, Florida, Michigan, Ohio, Arizona, Nevada, New Mexico, and North Dakota have all openly endorsed expanding Medicaid in their states.
However, the legislatures in Florida, Michigan, Ohio and Arizona -- under Republican control -- are having none of it.
Republicans who control Michigan's legislature "are not going along" with Governor Snyder -- even though expanding Medicaid in the state will provide health care for 320,000 vulnerable residents, create 18,000 jobs, and generate $1.2 billion in state budget savings.
The story's the same in Ohio, where "Republicans who control the state legislature are taking the Medicaid expansion out of the governor's budget," and Florida, where the Republican state House Speaker infamously touted his own family's past reliance on Medicaid while refusing to allow other Floridians access to the program under Obamacare.
And in Arizona, Republican lawmakers are having press conferences denouncing Governor Jan Brewer, declaring that her support of expanding Medicaid is "an expansion of big government."
We have reached a new low point in American politics when Republicans are denouncing Jan Brewer as a "big government" liberal.
The fact is, Americans overwhelmingly support accepting federal money to expand Medicaid in their states. Voters don't like the idea of seeing their tax dollars buy health care for New Yorkers and Californians while receiving nothing in return.
So why are Republican legislators risking backlash from the majority of their states' voters? Why, especially, when the alternative is to provide health care for millions of people in need, create tens of thousands of jobs in their states, and generate billions of dollars of economic activity and budget savings?
One Republican legislator summed up why so many Republicans are so willing to buck their state leaders and the benefits of this program: "It is good politics to oppose the black guy in the White House right now, especially for the Republican Party."
It's an ugly excuse for denying one's constituents health care, but it's the only excuse we've heard that skips over the ideological contortions required of Republicans seeking to block Medicaid expansion.
Democrats, on the other hand, face none of the internal inconsistencies plaguing Republicans.
Across the country, Democrats are pushing to expand Medicaid. In Iowa, the Democratic controlled Senate passed Medicaid expansion, even though the state's Republican governor and Republican controlled House have vowed to block the bill.
During debate, Iowa's Senate Majority Leader Mike Gronstal (D-Council Bluffs) summed up why Democratic lawmakers in red states and blue states have embraced expanding Medicaid.
"The more people we can get coverage, the more people will get primary and preventative care, the more we'll save," Gronstal said. "It's just wrong leave kids out and it's just wrong to leave adults out."
America's governors and legislators have been handed a tool that has the ability to make people's lives better, but many Republicans would rather score political points than save their constituents lives.