New Jersey Gov. Chris Christie's decision to expand Medicaid under Obamacare puts him alone among Republican governors vying for the 2016 presidential nomination, and could come back to haunt him among primary voters.
Some of his potential rivals who are also governors have sought ways to leverage federal money, and others have spurned the Medicaid expansion altogether. Mr. Christie, however, embraced President Obama's vision of expanding the federal-state health care program for the poor to those with incomes up to 138 percent of the poverty level.
Mr. Christie, like many other Republican governors, did reject efforts to have New Jersey set up its own health care exchange, but his embrace of Medicare does create a political problem similar to the one that dogged 2012 Republican presidential nominee Mitt Romney.
"The farther away from Obamacare any governor is, the better off they are," said Charlie Gerow, a board member at the American Conservative Union, which grades members on their commitments to conservative values.
He said Mr. Christie will have to position himself as a problem solver who deserves a pass from conservatives for trying to tackle a thorny issue.
"The problem is there is some nuance to all of that, and politics is not about nuance," Mr. Gerow said.
States had two major decisions to make regarding the Affordable Care Act: whether to set up their own exchanges — deemed a pro-Obamacare move — and whether to expand their Medicaid rolls, taking advantage of the federal government's offer to pay 100 percent of additional costs through 2016, after which states would pick up 10 percent.
Mr. Christie's office last week pointed to the governor's fiscal 2015 budget plan, which said the "expansion of health care for New Jersey's most vulnerable is already having a positive impact on coverage for our state," saving taxpayers about $181 million in the coming year and covering nearly 300,000 residents.
The governor has said Medicaid expansion was the right decision for his state, even if he views the federal health care law overall as "wrong for New Jersey" and "wrong for America."
"The saving grace is there are a lot of other governors who did take it," said Lanhee J. Chen, a Hoover Institution fellow who advised Mr. Romney's campaign on health care policy.
But those governors, such as Arizona's Jan Brewer and Ohio's John Kasich, do not possess the prominence and 2016 ambitions that Mr. Christie honed through a straight-talking approach to governance in a traditionally Democratic state.
Among Mr. Christie potential rivals, Texas Gov. Rick Perry and Louisiana Gov. Bobby Jindal rejected Medicaid expansion and a state-run health care exchange.
Wisconsin Gov. Scott Walker didn't sign up for full expanded Medicaid but did take steps to make sure residents didn't fall into an odd "coverage gap" that could have left some ineligible for either Medicaid or Obamacare's exchange subsidies.
Two years out, political analysts say, it's hard to say whether health care choices will be top-tier subjects on the campaign trail. But it certainly will be a factor, they say, and Mr. Christie and other Republicans who have tried to serve their states' interests may face uphill battles in primaries that lean to the political right.
"Certainly it's always tough to translate everything you do, when you have to govern a state, into something that works into a primary campaign," Mr. Chen said. "It's not always an easy transition to make."
Mr. Romney discovered that two years ago when he struggled to explain why state health care reforms he shepherded in Massachusetts did not jibe with Mr. Obama's approach, even though "Romneycare" served as a template for the national law.
Mr. Perry should have no problem selling his stance on Obamacare to conservative primary voters. He has called the law a "stomach punch" and a "monstrosity."
But a general election contest could offer questions about whether Mr. Perry did enough for Texas' large uninsured population, as some in the Lone Star State find their incomes too high for Medicaid but too low to qualify for subsidies on the federal health care exchange. The gap results when state leaders refuse to expand Medicaid.
Mr. Walker took a Solomonic path to close such a gap. While rejecting Obamacare's expansion, Wisconsin made sure its Medicaid program covered everyone up to 100 percent of the poverty line, the threshold to qualify for Obamacare subsidies.
"We provide health care access to everyone living in poverty, help transition those above poverty into the marketplace, reduce the number of uninsured and limit the future risk to Wisconsin taxpayers," Mr. Walker told the Milwaukee Journal Sentinel this month for its series on gubernatorial candidates.
Indiana Gov. Mike Pence, a Republican whose name is sometimes bandied about in 2016 chatter, has sought a federal waiver to expand Medicaid through a set of market-oriented reforms that emphasize personal responsibility. This way, his state can leverage federal funding without making it look like he is embracing Obamacare.
Some conservatives have called out Mr. Pence on the plan, but the flip side could be worse: Will voters accept candidates who flout Obamacare but have no health care reform plan of their own?
"If you're going to run for president of the United States, voters expect you to have a set of fairly specific proposals on a variety of issues that affect the nation," said G. Terry Madonna, a politics professor at Franklin & Marshall College in Lancaster, Pennsylvania.
In April, Mr. Jindal rolled out a blueprint to repeal and replace Obamacare. The plan reflected the Louisiana governor's experience as a health care policy prodigy in the 1990s and elevated him among potential presidential contenders.
The blueprint relies on states to set up their own reforms. A grant pool of more than $100 billion would be doled out over the next decade to let states subsidize insurance for low-income residents and, as a precondition for the funding, make sure people with pre-existing health problems are not denied coverage.
Having a plan in hand would allow Mr. Jindal to be more aggressive during primary debates, Mr. Gerow said, which is "where this issue comes to the fore."
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