Who Loses When a State Declines the Medicaid Expansion?

Source: Health & Social Work, Volume 39, Issue 2, May 2014
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From the extract:
Kris Crawford knows a thing or two about health care and politics because he is both an emergency medicine physician and a South Carolina state legislator. He stated publicly that he believed his state should take the federal money made available to it under the Patient Protection and Affordable Care Act (PPACA) (H.R. 3590, 2009) to expand Medicaid to the uninsured with incomes less than 138 percent of the federal poverty level. However, when it came down to voting whether South Carolina would expand Medicaid, he was part of the unanimous Republican opposition that sank the legislation. In a moment of remarkable candor, he explained his flip-flop to the press by stating, “It is good politics to oppose the black guy in the White House right now, especially for the Republican party”.

Dr. Crawford not only ignored his original opinion, he also went against the preference of 65 percent of adult South Carolinians. The public’s opinion regarding PPACA and, specifically, the Medicaid expansion, has been polled in South Carolina and four of the other southern states (Alabama, Georgia, Louisiana, Mississippi) that just said no. Three out of five adult residents want the Medicaid expansion, including solid majorities in all age groups, all races, all educational levels, and among self-identified political independents.

So why are so many Republicans voting against known preference of the majority? The principal reason is the fear that, if they do not conform with respect to opposing PPACA, they will be challenged in their next primary by a more conservative hard-liner who will stand an excellent chance of winning over the 59 percent of Republicans who oppose the Medicaid expansion and the 70 percent who oppose the entire bill….