Republicans in Congress and statehouses across the country harbor an antipathy to Medicaid that is impossible to explain, except as hostility to the poor families that are its chief beneficiaries.

Sam Brownback, the GOP governor of Kansas, translated ideology into action on Thursday when he vetoed a bill that would have made Kansas the 32nd state to expand Medicaid under the Affordable Care Act. The measure would have brought health coverage to as many as 180,000 of his state’s residents, with the federal government picking up 95% of the tab this year. Yet in his veto message Brownback called the expansion an “irresponsible” budget-buster.

That’s not the only flaw in Brownback’s statement. He calls Medicaid a “welfare” program, which isn’t true, and alludes to “restarted negotiations” in Washington, D.C., to repeal the ACA, which already have broken down. He gripes that the expansion bill passed by the Kansas legislature doesn’t cut off funding for Planned Parenthood, which of course is a Republican blind spot that no medical treatment can probably cure. He also took a coded swipe increasingly heard from the GOP by identifying the expansion beneficiaries as the “able-bodied.” More on that in a moment.

First, let’s examine some of the other common right-wing slams of Medicaid. One often heard from House Speaker Paul D. Ryan, R-Wisc., and Health and Human Services Secretary Tom Price is that Medicaid patients can’t find doctors to treat them. “One out of every three physicians in this nation aren’t seeing Medicaid patients,” Price said recently; Ryan’s version, uttered during a press conference earlier this month but repeated endlessly, is that “more and more doctors just don’t take Medicaid….That is a huge, growing problem with Medicaid.”

The Idaho Senate earlier this month rejected a Democratic plan that would have brought an estimated 78,000 residents under Medicaid’s umbrella, and the idea appears to be dead for the year. Republican Gov. Butch Otter has said that expansion “would mean subordinating our Idaho priorities to the siren song of federal dollars.” In Missouri, Gov. Eric Greitens has blown off a Democratic legislative effort to expand Medicaid. Republican legislators in Virginia remain united against Democratic Gov. Terry McAuliffe’s drive to cover as many as 400,000 Virginians.

Elsewhere, the collapse of House Republicans’ ACA repeal measure has prompted Republican-dominated statehouses to reconsider their long opposition to Medicaid expansion. That includes Georgia, where Gov. Nathan Deal said he would consider some form of expansion, possibly through a federal waiver that would allow the state to fashion its own version of expanded Medicaid. But that probably won’t happen this year, and opposition remains strong in the legislature.

Brownback’s veto was expected, because although the legislature’s expansion measure won great support even among Republicans, it didn’t reach the two-thirds majority needed to override a veto. Efforts are underway now to drum up enough additional votes to do so within the 30-day window allowed by Kansas law.

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Despite evidence that Medicaid works, Kansas Gov. Sam Brownback vetoes expansion