Given the highly charged partisan nature of debate over the Affordable Care Act, sometimes it’s easy to forget that the debate in states over accepting the ACA’s funding for state Medicaid expansion efforts is largely a debate among Republicans. In Washington the ideological debate between the parties centers around repeal of the ACA.  In the states however, conservative state governors are developing alternative health plans to use the federal Medicaid dollars that usually garner strong overall support among Democrats – and so the debate around these Medicaid plans moves to a discussion among Republicans.

Here’s a video that illustrates this point well. Last month when Tennessee Governor Bill Haslam (R) made a first attempt to implement his reform-driven “Insure Tennessee” plan for using federal Medicaid expansion dollars earmarked for his state there was interesting testimony from many citizens. The Tennessee Justice Center has been highlighting some of this testimony and in this video below a nurse practitioner, who declares herself a Republican, is quizzed by two Republican state legislators – one pro “Insure Tennessee” and one against. So a Republican witness testifies about the need for a Republican Governor’s Medicaid plan and answers questions from two Republican legislators; it’s a refreshing illustration that the debate over how to expand health coverage to poor working people doesn’t have to involve partisan back and forth but honest discussion about the issues at stake.  Of course, Haslam’s plan was initially defeated shortly after its first appearance (although it may be back) – showing disagreement even within one party around the wisdom of accepting the Medicaid expansion dollars isn’t magically going away any time soon.  Still, the exchange below does give me hope that states will continue to move towards making the Medicaid decision on practical rather than ideological grounds.