In Their Own Words: Republican Governors Support Medicaid Expansion

If Congress repeals the Affordable Care Act, it will also eliminate one of the law’s most popular and successful elements: the expansion of Medicaid to cover people with low and moderate incomes. This would be a terrible mistake.

Medicaid expansion is responsible for expanding access to health care and benefitting state economies, and has bipartisan support. Eleven Republican governors, that’s a third of all Republican governors in the country, have chosen to expand Medicaid. This includes Vice President-Elect Mike Pence, who expanded Medicaid when he was governor of Indiana. Seventeen states that have expanded Medicaid now have Republican governors.

Governor Terry Branstad (R-Iowa) – a member of the incoming Trump administration – called Medicaid expansion “a win for the people of Iowa” when he signed Medicaid expansion into law in 2013. Governor Brian Sandoval (R-Nevada) has said Medicaid expansion is one of the best things to happen to the state, according to Governor Matt Mead of Wyoming (R), another supporter of expansion.

Many Republican governors in both expansion and non-expansion states have been supportive of Medicaid expansion, rightly arguing it both helps state economies and gives hard-working, low-income people access to health care. In their own words, here are some of the arguments Republican governors have used to promote and celebrate the success of Medicaid expansion in their states.

Medicaid expansion helps low-income workers gain access to health care. Governors across the country know that Medicaid expansion give a hand up to hard-working state residents.

• “[Hoosiers in the coverage gap are] hard working men and women, who are rolling up their sleeves oftentimes in the most difficult circumstances, but courageously move forward in providing for their families. […] [T]heir income simply doesn’t give them the ability to purchase health insurance for themselves or their families.” – Vice President-Elect Mike Pence (R-Indiana), May 2014
• “We all know someone that falls in that category: hard-working people but lower-income people that couldn’t afford health insurance.” – Governor Rick Snyder (R-Michigan), August 2013
• “We are going to extend Medicaid for the working poor….” – Governor John Kasich (R-Ohio), February 2013
• “We also have to remember those who would benefit, such as the single mother of three who simply cannot work enough hours to exceed the poverty line for her family.” –Governor Dennis Daugaard (R-South Dakota), December 2015

Medicaid Expansion has been a critical tool in helping governors fight the opioid epidemic and mental health crises. Particular in the Midwest, where the opioid epidemic has hit families hard, Medicaid expansion has been there to help governors fight back.

• “[With Medicaid expansion] I had a chance to bring home to Ohio…to do some things that frankly needed to be done. And that’s to treat the mentally ill, to get them across the bridge so they can get employment. The same for the drug addicted and you know drug addiction is in every demographic, every income, every community. To treat those people, rehab them, and get them to work.” – Governor John Kasich (R-Ohio), November 2013
• Governor Kasich, just this week, added, “Thank God we expanded Medicaid because that Medicaid money is helping to rehab people.” – Governor John Kasich (R-Ohio), January 2017

Vice President-elect Mike Pence cited the number of people enrolled in Medicaid expansion (called HIP 2.0 in Indiana) as a critical factor in stemming the HIV and hepatitis C outbreak caused by shared needles in Scott County, Indiana, in 2015.

• “The number of Scott County residents enrolled in the Healthy Indiana Plan (HIP 2.0) has risen from 838 in March 2015 to 1,858 in February of this year. This means more than 1,000 people can now access care that will help them get and stay healthy.” – Vice President-Elect Mike Pence (R-Indiana), April 2016

Medicaid expansion helps keep people who are sick and uninsured out of hospital emergency rooms, strengthening hospital finances. Before expansion, when you were poor and sick, the only place to see a doctor was in the emergency room. Medicaid expansion allows state residents to get care in the most appropriate setting.

• “And also to make sure the working poor have a system that makes sense, instead of showing up and getting all their healthcare in emergency rooms.” – Governor John Kasich (R-Ohio), November 2013
• “It’s all about saving money by being smarter. When uninsured people go to the emergency room for non-emergency care — instead of seeing a primary care doctor — it costs hospitals millions each year in uncompensated costs. By expanding Medicaid, people will have access to primary care doctors, saving Michigan hospitals those uncompensated care costs…. Not only are we saving money, but we’re helping to improve the health of all Michiganders.” – Governor Rick Snyder (R-Michigan), February 2013

Medicaid expansion helps state budgets and state economies. Governors know that Medicaid expansion is good for their budget, often providing millions of dollars in state budget relief each year. The influx of federal funds from expansion also stimulates state economies, helps hospital finances and creates jobs in the health care sector and beyond.

• “[By expanding Medicaid] we will protect rural and safety-net hospitals… take advantage of the enormous economic benefits… [and] save and create thousands of jobs… With the realities facing us, taking advantage of this federal assistance is the strategic way to reduce Medicaid pressure on the state budget. We can prevent health care expenses from eroding core services such as education and public safety, and improve Arizona’s ability to compete in the years ahead.” – Former Governor Jan Brewer (R-Arizona), January 2013
• Governor Brewer, an early supporter of President-elect Donald Trump, said she is going to urge him to keep the Medicaid expansion, using Arizona as a model since it is so cost-effective. She said, “I don’t know how you could deliver that population any more services better, more cheaply, than what we’ve already done here.” – Former Governor Jan Brewer (R-Arizona), November 2016
• When discussing the fiscal plight of the state of Wyoming, and critical federal dollars expansion could draw down, Governor Matt Mead (R-Wyoming) said “I’m trying to be pragmatic, recognizing that we have about 18,000 people who could obtain coverage. We have small hospitals that are struggling.” – Governor Matt Mead (R-Wyoming), December 2015
• Governor Mead also said that health expenses from the 20,000 Wyomingites expected to be covered under Medicaid expansion are part of the $100 million in uncompensated care costs Wyoming’s hospitals absorb each year. According to Governor Mead, Wyoming is losing $310,000 each day that Medicaid is not expanded. – Governor Matt Mead (R-Wyoming), February 2016

Governor Chris Christie (R-New Jersey) has touted the positive impact of Medicaid expansion on the New Jersey state budget numerous times:

• “Accepting these federal resources will provide health insurance to tens of thousands of low-income New Jerseyans, help keep our hospitals financially healthy and actually save money for New Jersey taxpayers…Expanding Medicaid…is the smart thing to do for our fiscal and public health.” (Christie estimated it would save state residents $227 million in the next fiscal year). – Governor Chris Christie (R-New Jersey), February 2013
• Later, in an August 2016 statehouse news conference, Governor Christie said over half a million additional New Jersey residents now have access to health care due to the expansion and that the state has saved money on its overall share of Medicaid expenses. He said he was “proud” that New Jersey was getting healthcare at a lower cost. “There were naysayers, both inside the state and around the country…They were wrong then and they’re proven wrong now.” – Governor Chris Christie (R-New Jersey),  August 2016

Medicaid expansion makes sense, not just for fiscal reasons, but for moral ones as well. Many governors found motivation to expand Medicaid not just in their states’ finances, but also in their faith.

• “It’s pro-life, it’s saving lives, it is creating jobs, it is saving hospitals…I don’t know how you can get any more conservative than that.” – Former Governor Jan Brewer (R-Arizona), July 2013
• “We have an obligation to provide an adequate level of basic health care services for those most in need in our state. However we also have an obligation to ensure our state’s financial security. In deciding to expand Medicaid, I weighed every possible outcome and impact. Ultimately, this decision comes down to what is best for New Mexicans.” – Governor Susana Martinez (R-New Mexico), January 2013
• “We’re a compassionate state, and we’re not going to leave 220,000 people without some recourse.” – Governor Asa Hutchinson (R-Arkansas), December 2015
• “We want to see all of our citizens have access to affordable health care.” – Governor Doug Ducey (R-Arizona), November 2016