For the first time since Obamacare split the country in two, the conditions for a cease-fire have begun to appear.
An architect of this detente — although he denies any such intent — is Mike Pence, who as a conservative Republican congressman in 2010 fought bitterly against the law, and who as governor of Indiana refused to implement it.
But Pence, after intensive negotiations with the Obama administration, just announced his intent to take the money Obamacare provides for Medicaid expansion and to use it on his own terms to broaden health care coverage for the working poor.
For Pence, a happy warrior for conservatism and a possible 2016 presidential contender, the reason is pragmatic: If he could get money under an Obamacare waiver to enlarge a market-driven health care program in his state, there would be no point in cutting off his nose to spite his face.
“When it comes to the issue of health care, I believe that people in my party need to be solutions conservatives, offering real alternatives to the big-government answers,” he lectured Monday at the American Enterprise Institute, a center-right think tank, on a visit to Washington. Conservatives, he said, “need to ensure that the safety net is well-designed and strong to provide a firm basis for those starting out on life’s ladder.”
This was an implicit rebuke of his former House colleagues who have a “repeal and replace” slogan but have not offered much of a substitute for Obamacare while at the same time attempting to cut food stamps and other parts of the safety net.
Pence, a former head of the conservative Republican Study Committee in the House, was a tea party Republican before there was a tea party. But running a state has given him an elevated perspective.
“Debates that happen in Washington, D.C., pretty easily get far afield of the real-world impacts on real people,” he told me Monday afternoon. “It will not be enough for new Republican majorities in the Congress and a Republican president to cut government spending,” he added, calling instead for money to be sent to the states so they can “solve the intractable problems.”
Pence isn’t about to admit it, but Obamacare does this.
He thinks he has a conservative alternative to the new law’s expansion of Medicaid: He wants to broaden the Healthy Indiana Plan started by his predecessor, Republican Mitch Daniels, by using financial incentives to get the working poor to contribute to their health coverage under a private alternative to Medicaid. The Obama administration appears likely to grant Indiana a waiver for the experiment — and if it works, other states will be free to follow the example.
Starting in 2017, states will be able to experiment further, securing exemptions from problematic provisions of the law such as the individual mandate, the employer mandate and the health care exchanges. If Republican governors don’t like Obamacare’s requirements, all they have to do is come up with an alternative that provides comparable care and coverage.
Pence declined to speculate about whether he might seek a waiver exempting Indiana from Obamacare overall. He continues to support the law’s repeal, and he spent a good chunk of his AEI speech bemoaning its flaws.
He has to do this if he wants to compete in Republican presidential primaries. Although not usually mentioned in the top tier, Pence is well positioned at a time when the party’s strongest candidates are governors. He has a better record than New Jersey’s Chris Christie, is smarter than Texas’ Rick Perry, is not as divisive as Wisconsin’s Scott Walker and is more conservative than former Florida Gov. Jeb Bush. He speaks the language of Christian conservatives — twice in his AEI speech he wove in biblical passages from Luke without citation — and his Medicaid experiment should earn him some moral authority.
While other GOP governors continue to refuse the Medicaid expansion money, Pence reminds them, and everyone, that “we’re talking about real people, working people who deserve a better way.” He made it his administration’s job to help the “proud Hoosiers” — people “who find themselves essentially, for all intents and purposes, caught in that gap where their income simply doesn’t give them the ability to purchase health insurance for themselves or for their families.”
This is what Obamacare is all about. As more conservatives realize that the law they hate allows them to implement policies they like, they may have trouble recalling what all the fuss was about.
Dana Milbank is a columnist for The Washington Post. His email address is email@example.com.