Medicaid and Medicare

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With Republicans in control of the White House, both chambers of Congress, and 34 out of 50 governorships, it would have been hard to imagine a more politically advantageous alignment for a conservative overhaul of Medicaid. President Barack Obama's Affordable Care Act expanded Medicaid to cover more low-income adults, many of them working jobs without health insurance. Thirty-one states have accepted the ACA's expansion, covering about 11 million people.

The GOP bills would have phased out funding for Obama's expansion, and also placed a limit on future federal spending for the entire program — a step now seen as overreach. Spending caps in the House and Senate bills translated to deep cuts that divided Republicans. And GOP governors who had expanded the program couldn't swallow the idea of denying coverage to hundreds of thousands of constituents. Some went public with their opposition, while others quietly warned their congressional delegations about dire consequences.

Medicaid "is not yet at the Medicare and Social Security level because it isn't framed as something that you contribute to during your working years and you get it later as a commitment," said Diane Rowland of the nonpartisan Kaiser Family Foundation. "But I think there is a recognition that for all its flaws...it's really the nation's health care safety net."

An AP-NORC poll taken last month found the public overwhelmingly opposed to GOP Medicaid cuts, by 62-22. "You just can't do this to people who are in situations that they didn't put themselves in," said Sara Hayden of Half Moon Bay, California. Unable to work as a data journalist due to complications of rheumatoid arthritis, she was able to get health insurance when her state expanded Medicaid.

New Life for Medicaid after GOP's Healthcare Debacle