Remember when repealing Obamacare was the battle cry of Republicans? Who can forget the image of a terminally ill John McCain slowly entering the Senate chamber late at night to give a thumbs down “no” vote to even “skinny” repeal of Obamacare.

Fast forward nearly a decade, and one of the most enduring aspects of Obamacare is the Medicaid expansion it spawned. As you will recall, Obamacare induced states to expand Medicaid by promising to have the federal government fund 100% of the expanded population.

Who would be these new Medicaid recipients under Obamacare? Well, they would be people previously ineligible for Medicaid because they made too much money, or they were able-bodied and had no serious illnesses.

Ironically, Obamacare’s Medicaid expansion granted wealthier, healthier, able-bodied patients at a 100% federal subsidy while sicker, poorer patients received a federal subsidy of closer to 60%. 

“What’s not to like?” said most Democrat governors and a handful of Republican governors — free medical care paid for by the federal government, at no cost to the state government at all! If there ever was something for nothing, this certainly sounded like it.

After a few years, the federal government’s share would drop to 90%, but hey, still quite the bargain for the states. Unless, of course, a pesky taxpayer should bring up … “Don’t we pay federal taxes, also?”

Supporters of Medicaid expansion, though, likely would reply, “But not to worry, Congress had a printing press over at the Fed.”

But as the debt explodes and interest payments now approach a trillion dollars annually, conservatives have asked — what is the cost to the taxpayer? Turns out the program costs over $800 billion today.  

So, energetic conservatives proposed adding this reform to the Big ‘Not So Beautiful’ Bill. The reform wouldn’t have even required cutting anyone off Medicaid. The reform would be to simply cap the program, and any new patients would be added at the traditional formula, which has the federal government paying on average a little more than 60%.

Some Obamacare apologists argued that the states couldn’t afford to keep all these people on Medicaid if the states had to pay their fair share. But that’s precisely the point of shifting expenses from the federal government (seemingly endless borrowing capacity via the Central Bank) to the state governments, which are, by necessity, limited in their borrowing capacity. 

Shouldn’t we be honest with each other? If, as a society, we want to give free health care to over 20% of the public, shouldn’t we demand that taxes be raised and pay for the welfare state in an honest fashion?

My hope is that taxpayers would decide that incentivizing work and private insurance is better than debilitating tax increases.

But as the Big ‘Not-So’ Beautiful Bill ripened and the vote-buying extravaganza unfolded, weak-kneed Republicans balked, chafed, lamented, and ultimately refused to consider any reform to this expensive relic of Obamacare.

So, Republicans failed to do what they campaigned on for several cycles — repeal any aspect of Obamacare. Reducing the federal government’s subsidies for Medicaid expansion would have saved an additional $710 billion over ten years and fully offset all new spending in the Big ‘Not So’ Beautiful Bill. 

Conformity won. Conservatives lost. Republicans blinked, and the Big ‘Not So’ Beautiful Bill kept Obamacare’s Medicaid expansion.