With occupancy of the White House and majority control of both chambers of Congress, you’d think being a Republican in Washington would be an easy job these days.

But members of the GOP find themselves in a quandary on the subject of health care. Moderate Republicans and the far right faction that helped drive Donald J. Trump to victory in November are quite far apart on the issue. Both moderates and conservatives are united in their disdain for Obamacare but are at a loss for a solution that would scrap and replace it, due in no small part to Medicaid.

Medicaid, the federal government’s health insurance program for low-income families, is a spending behemoth that has plagued Democrats and Republicans alike for a generation.

Expanding Medicaid is something of a political carrot. Besides being morally justifiable because it helps us take care of our own, it’s a sure vote-getter, which is the end-all in our nation’s capital. Paying for Medicaid, on the other hand, is something of a political nightmare, especially as our nation’s debt soars past the $20 trillion mark.

Welcome to the GOP’s dilemma. When Democrats took control of Washington in 2008, they were able to pass the Affordable Care Act because their base was united on health care reform. The Republicans have no such luxury. Conservative members of Congress are anxious to send news back to their districts that they’re finding ways to cut spending, while moderate members of Congress are reluctant to tell their constituents that they’re cutting health care coverage for some Americans.

Obamacare poured hundreds of millions of additional dollars into Medicaid through 100 percent reimbursement to states choosing to increase the program’s eligibility threshold to 138 percent of the poverty level for non-disabled, working-age adults. Tennessee was not among the states to accept the 100 percent reimbursement — which is scheduled to dwindle to 90 percent reimbursement by 2020 — because that same moderate vs. conservative divide played out here. With Gov. Bill Haslam, a moderate Republican, proposing to accept the federal funding for TennCare expansion through his Insure Tennessee plan, the measure garnered some support from his fellow moderates in the state legislature — like State Sen. Ken Yager, R-Kingston, who represents Scott County — but the more conservative members were able to prevent the proposal from even leaving committee.

Now that Republicans have control of Congress, their own health care plan calls for rolling back Obama’s Medicaid expansion. As we speak, an argument is playing out between Democrats and Republicans over the accuracy of a report by the nonpartisan Congressional Budget Office that the current GOP health care proposal would leave 22 million more Americans uninsured. Waking through the propaganda being shoveled by both sides to find the truth is not an easy task. But a more important statistic might be what the current repeal plan would mean for Tennessee.

According to the Tennessee Justice Center, a somewhat nonpartisan yet somewhat left-leaning advocacy organization that is unabashedly opposed to Obamacare repeal efforts, the current GOP plan would cut Medicaid funding in Tennessee by $500 million annually. If that call to action is substantiated, it would be alarming for rural communities with higher-than-average poverty rates where the community hospital is an employment lifeline but is at danger of closing.

If that sounds familiar, it obviously should. As the Insure Tennessee battle broiled in Nashville, former District Attorney General Wm. Paul Phillips testified before a panel of state legislators, saying Scott County’s hospital was in danger of closing if the General Assembly did not act to expand Medicaid.

The legislature did not act, and Scott County’s hospital did close. It’s safe to say that the hospital’s closure was more about corporate mismanagement by Pioneer Health Services than a lack of Medicaid funding, but there’s also no denying that increased federal dollars flowing into the Medicaid program would be a significant shot in the arm to rural hospitals like the soon-to-open (we hope) Big South Fork Medical Center.

That’s the part moderate Republicans are hanging their hats on: what happens to rural hospitals — and rural communities — if Medicaid is cut? But it doesn’t excuse the part that fiscally-hawkish conservative Republicans are hanging their own hats on: how do we pay for it?

Medicaid itself is in a pickle. When it was established as a safety net in 1965, Congress didn’t envision that its enrollees would eventually number 70 million. Throw in the 20 million who are on Medicare, and the number of Americans receiving government-funded health insurance is quickly nearing 100 million. And the Congressional Budget Office said last month that if Obamacare is not repealed or amended, the ranks of those on Medicaid alone will swell to 86 million by 2026. That doesn’t take into account the fact that the cost of expansion was under-estimated when the Affordable Care Act was adopted. Add it all up and it’s quite a burden for America’s taxpayers — the high-earners and the middle-earners alike.

This is the GOP’s dilemma. It’s the proverbial rock and a hard place. Cutting Medicaid would cost them votes. Leaving Medicaid alone will cost them votes. The choice is clear: do you vote to strip some Americans of their health care coverage, or do you vote to saddle taxpayers with additional burden?

If you choose Option A, I present to you a child who has leukemia, and whose family would be at risk of losing Medicaid benefits with no way to pay for his treatments. If you choose Option B, I present to you a single-wage-earning family of four, with too much debt and weekly paychecks that are stretched to the max, worried about how to make ends meet while watching a not-insignificant portion of that weekly check cut out for taxes.

Which one are you going to side with? When you figure it out, write your congressman.

ν Ben Garrett is Independent Herald editor. Contact him at bgarrett@ihoneida.com.