A confederacy of cruelty
This map should break your heart.
In white are the 24 Republican-led states that have refused to expand Medicaid as part of the Affordable Care Act. One state — Scott Walker’s Wisconsin — actually used expansion to kick some of its residents off Medicaid.
The results of this act of “spite,” as President Obama called it, are staggering.
5 million Americans who earn too much to be on Medicaid will remain uninsured.
The states who deny this coverage will have to pay for it in four ways: 1) taxes they can’t opt out of; 2) premiums in the health care exchanges will be higher by as much as 15 percent; 3) hospitals will see an estimated cut of 2.5 percent to their margins, which will likely cause many in these states to close, and 4) people, as many as 27,000 of them, will die for lack of insurance.
Leaving 5 million people in the Medicaid Gap “directly contradicts the main ambition of Obamacare,” The Incidental Economist‘s Austin Frakt told Dan Diamond who has been tracking Medicaid expansion for The Advisory Board Company. That goal was to equalize health care options for low-income throughout the United States.
When the Supreme Court upheld the individual mandate, it also ruled that states can opt out of Medicaid expansion without negative consequences. Unlike many of the worst decisions of the Roberts Court, this ruling was joined by two liberal judges. But, like its expansion of the ability of mostly white male rich people to dominate campaigns and its limits on Affirmative Action and voting rights, this decision had a disproportionate affect on minorities, under the guise of being “colorblind.”
After screaming about millions of insurance cancellations, which have turned out to be grossly inflated, how can Republicans justify denying coverage to 5 million of the hardest working people in America?
The answer is repulsive: The people most likely to benefit from this law and to be denied coverage by refusing expansion are people who are not likely to vote.
The Washington Post’s Greg Sargent doubts many Democrats running in states won by Mitt Romney want to stake their future on tying themselves to a law that didn’t win over their constituents when turnout is likely to be its highest. He thinks the issue will recede as both sides prefer confront the issue that will likely decide these elections: the economy.
It may be a smart strategy but it lets Republicans off the hook.
The New Republic‘s Brian Beutler suggests that now that its clear that the winners from the law greatly outnumber the losers, and Republicans are intentionally creating 5 million losers, Democrats should come out swinging for Medicaid expansion.
In Michigan and Colorado, states President Obama won, Democrats Mark Udall and Gary Peters have engaged in this strategy to some degree.
Likely Republican nominee for the U.S. Senate in Michigan Terri Lynn Land becomes even more incomprehensible when discussing what she’d do about Obamacare. She claims to be for Medicaid expansion but if she somehow wins, she almost certainly be a majority bent on full repeal. Her murkiness will likely turn off the GOP base, the only people in the world who think repeal is actually an option. Imagine if she were forced to say she’d vote against full repeal in the Senate.
Could this work in red states?
In Louisiana, Medicaid expansion could literally be on the ballot. And Medicaid expansion is far more popular everywhere than Obamacare. In Georgia, there’s a grassroots movement to demand expansion. In Kentucky, the law is working better than nearly any blue state.
The GOP’s absurd claim that people are better off with no insurance than Medicaid coverage defies both research and common sense.
This is an issue of such moral and economic clarity that Democrats would be foolish not to point out over and over again that all Republicans have to do to ensure 5 million Americans is just to say yes.
Attempting to deny Americans the right to vote backfired in 2012 and brought more young people and minorities to the polls in 2012. Literally denying people health insurance could reshape the electorate in ways that cannot be imagined now — and not just because it will bring young people and minorities to the polls.
Reminding people that Republicans will deny people Medicaid is an excellent reminder that they will deny people traditional Medicare.
Democrats should bet that the American people will reject abject cruelty. And if that doesn’t feel like a safe bet, bet on Republicans saying terrible things as they try to explain why 5 million Americans have been denied something their state is paying for anyway.