The White House and Harry Reid are preparing to give Ben Nelson anything he wants in exchange for his vote. It appears that this anything could be a gutting of the single best remaining piece of reform, Medicaid expansion:

Earlier Thursday, in an interview with a Nebraska radio station, Nelson said even if the abortion issue were resolved, he still could not support the $848 billion package, complaining that the plan to cover more than 30 million additional Americans calls for dramatically expanding Medicaid, which is partially funded by the states. The Medicaid expansion would “create an underfunded federal mandate for the state of Nebraska,” Nelson said, arguing that states should be permitted to “opt out” of that idea and find other ways to offer coverage to their poorest residents.

Expanding Medicaid is the most cost effective way to increase insurance coverage. It is responsible for covering roughly half of the 30 million Americans who would gain “coverage” under the Senate bill. While Medicaid is not perfect, it is real health coverage. It is not like the junk 60%-actuarial-value “bronze” level insurance or “catastrophic” insurance that millions of the new “covered” will buy. The quality of those plans is so low, they are basically insurance in name only.

Expanding Medicaid to everyone below 133% (150% in the House bill) of the federal poverty line is the single most important provision remaining in the Senate bill. If it is seriously crippled, it would be a tragedy that should make every single Democratic senator question what is possibly left in the bill worth passing. If using reconciliation is the only way to protect the Medicaid expansion, the decision to use it should be a no-brainer for every real Democrat.

Update – Jed Lewison at Dailykos has more on Ben Nelson’s list of incredibly bad demands.