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Late in May I wrote about how Jan Brewer, the GOP Tea Party governor of Arizona, saw the light and went to bat for the Obamacare Medicaid expansion in her state, fighting tooth-and-nail against her once simpatico Tea Party legislature. Today I learned that she managed to prevail in her fight. Shows what all-out commitment will do – and maybe suggests just why our cautious, low-key Democratic governor isn’t able to achieve similar goals.

Of course, it looks like the GOP-dominated legislature may be having second thoughts about expanding access to Medicaid – or perhaps they’re just worried that blowback from such a wanton rejection of measures that would improve the quality of life for thousands of Missourians might hurt them in the long run, particularly when it becomes clear to Missourians just how costly the GOP’s mindless opposition to anything Obamacare will be for the state. It seems that both houses have now appointed panels that will prepare Medicaid “reform” legislation for the 2014 session.

Sadly, I fear that the reforms these ALEC-fearing jokers might have in mind might be almost as bad as going without. Last year, some GOP lawmakers supported changes that would have moved Medicaid into private, managed care systems – which have proven problematic in many states where they have been tried (see here, here and here) – and it’s likely that they will continue on down the path toward what State Rep. Jay Barnes (R-114) speculated could be “the most market-based system in the entire country.”

Of course, many healthcare economists are unequivocal that the biggest problem contributing to raising health care costs is simply our private delivery system with its perverse incentives and cumbersome administrative costs. Nor do we always get good value for the money spent. Oh well – if it gets more people into the system, I guess we can afford a little degradation in the service – it’s just the usual cost of doing business with ideologues and corporatists.