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View: Another 2016 contender takes Obamacare money

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(Bloomberg View) — Big news on Obamacare today — and perhaps for the 2016 fight for the Republican presidential nomination as well.

Gov. Mike Pence of Indiana has reached an agreement with the federal government to accept expanded Medicaid for the Patient Protection and Affordable Care Act (ACA), even while radically changing the state’s regular Medicaid system.

See also: Indiana wins approval to expand Medicaid.

It’s a huge deal because it’s another sign that the U.S. Supreme Court has only delayed the Medicaid expansion required under the law rather than preventing it altogether. If even a conservative firebrand such as Pence can’t hold out, it’s increasingly clear that the federal incentives for state governments to sign on are just too strong to resist. In Arkansas, new Republican Gov. Asa Hutchinson is asking the legislature to keep the state’s “private option” for the ACA’s Medicaid expansion, a compromise championed by his Democratic predecessor.

Overall, it’s now possible that despite last year’s Republican landslide, no state will roll back its coverage while a handful of holdout states will add it.

This doesn’t mean the law’s Medicaid expansion is anywhere close to a done deal nationally. But as long as it continues to be a one-way street, full compliance is only a matter of time, even if it takes a decade or so to get there. This is likely to accelerate once Barack Obama leaves the White House.

So what does this have to do with the 2016 race to replace him?

Pence has either decided not to run for president (and he’s been one of the slowest-moving viable candidates), or he believes that support for Medicaid expansion won’t ruin his conservative credentials — the same conclusion apparently reached by Gov. John Kasich of Ohio. Kasich, however, is more of a moderate figure who might be acceptable to the strongest conservatives. Pence really needs the enthusiastic support of those strong conservatives to be well-positioned for presidential politics, and it’s hard to see how this helps him.

If Pence is still running, perhaps he believes conservatives who want a viable candidate still have few alternatives. It isn’t as if Mitt Romney, Jeb Bush or Chris Christie are better for them despite this choice, and true-believer alternatives such as Texas Sen. Ted Cruz (or, more implausibly, Ben Carson) aren’t likely to be acceptable to the rest of the party.

Or maybe Pence has been actively seeking support but finding little, and was ready to drop out. One other possibility: Pence may genuinely but mistakenly believe he can persuade conservatives that the other Medicaid changes he is making in Indiana are more important than the trade-off of accepting the program’s expansion under Obamcare.

It’s too early to write Pence off as a presidential candidate without more evidence. But if he’s still hoping to be a contender, it might be a good idea for him to make a little noise pretty soon to make sure the Republican Party actors who are making the decision know about it.

See also: On the Third Hand: Two PPACA worlds.

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