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Pence Uses His Medicaid Expansion Plan as Sales Pitch to Governors

Vice president owns up to expanding entitlement in Indiana

Vice President Mike Pence on Friday made a sales pitch to Republican and Democratic governors for an emerging GOP-crafted health care bill. (Bill Clark/CQ Roll Call)
Vice President Mike Pence on Friday made a sales pitch to Republican and Democratic governors for an emerging GOP-crafted health care bill. (Bill Clark/CQ Roll Call)

Vice President Mike Pence grabbed the elephant in the room by the tusks Friday when he addressed Republican and Democratic governors, owning his decision as Indiana’s chief executive to expand Medicaid coverage under the 2010 health law.

Pence used his 2015 decision to accept federal funds to expand the program under Barack Obama’s health law as an example of how the Senate Republican leadership-crafted health bill would give governors greater control to shape their states’ health care regimes. The VP, as governor, used the Affordable Care Act-provided funds to expand Medicaid via a program unique to the Hoosier State.

Former Democratic Arkansas Gov. Mike Beebe joked during a Wednesday interview that the vice president should “change his position, probably” when asked how Pence might go about selling the Senate bill to the country’s governors.

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“It’s hard to take something away from somebody once they’ve got it,” Beebe said. “The fact that he took [the federal funds] makes it doubly hard to argue about taking it away. … It’s just, politically, a nonstarter for a lot of people.”

But Pence, a longtime Washington veteran who had risen to the House GOP leadership team before running for governor, flashed his political prowess when he pitched some aspects of the Senate plan as designed to allow state leaders to do similar things with their respective health systems.

Pence’s remarks, much of which were a sales pitch for a Senate bill that could get a floor vote as soon as next week. He told the state executives it would, if signed into law, give them the “freedom to redesign your health insurance markets.”

“This is your chance” he said of Republican lawmakers, adding this message to the governors: “We can put you back in the driver’s seat to put you back in control.”

At one point Pence told his former cohorts he wanted to “speak to you as a former governor.” He noted his Medicaid-expansion decision, and said he feels the frustration among some in the room that it has been “impossible for states to act on your own ideas.”

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He told them he learned that “first hand,” and it led him to decide to pursue his own “serious Medicaid plan.” The Pence administration program “put Hoosiers in charge of their own health care,” and created “more access” to coverage and care, he argued.

Democrats like former Centers for Medicare and Medicaid Services Administrator Andy Slavitt bristle at these kind of boasts, pointing out that the Obama-era CMS worked with states on waivers, particularly Pence in Indiana, so they could design their own programs. Their point is that governors have the option to apply for waivers to do exactly what Indiana did under the current law. 

He told the state leaders that he and President Donald Trump believe governors — not the federal government — should have the “freedom to design and implement” health care changes that they conclude would best work in their states.

“We’re going to fight to make that a reality in Washington, D.C.,” Pence said.

The former Indiana governor’s message was just what Jim Douglas, a former GOP chief executive in Vermont, told Roll Call earlier this week Pence should deliver.

“The traditional message from governors is: ‘We can be a good partner in exchange for more flexibility and fewer strings,” Douglas said. “There are ways to do that without a wholesale throwing people off Medicaid.”

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