Wise words from Ed Kilgore
He knows his Southern politicians:
I know, I know, it’s widely thought to be incontrovertible that logic, pressure from providers, and the sheer idiocy of states with stingy Medicaid programs turning down a massive redistribution of resources in their favor, will all convince Republican governors to go along with the Medicaid expansion after they kick and scream for the benefit of “the base.” Perhaps that’s true, and that the rhetoric is the latter-day equivalent of the “massive resistance” southern lawmakers pledged to wage against the federally-imposed demise of Jim Crow.
But as the civil rights precedent showed, the competitive pressure of demagoguery is sometimes a lot more powerful than the “business logic” of going along with a more rational course of action. Now that Scott and Jindal have thrown down the gauntlet, can Nikki Haley or Scott Walker or Rick Perry or Sam Brownback be far behind?
This is of more than academic interest since the design of ACA really does depend on Medicaid expansion. In states where Medicaid fails to cover those under the federal poverty line, there are potentially millions of people who will not qualify for the subsidies available to higher-income families participating in the health exchanges.
As I’ve said from the beginning, the moral heart of the ACA is the medicaid expansion (and the banning denial of pre-existing conditions.) This was the big payoff for liberals in this thing. The rest is an experiment in using “markets” to make it “more affordable” for middle class people in the private insurance market. (Like me.)Hopefully the subsidies and exchanges will work and many people will be better off. Certainly they’ll have better preventive coverage and no lifetime limits, so that’s something.
But expanding Medicaid to cover more than 10 million people, mostly working poor, who cannot afford to buy health insurance at all was the real liberal accomplishment of the Act, although some of us predicted from the beginning that it would also be the most vulnerable. (Hell, even the Obama administration has been willing to cut existing Medicaid, so it’s hard to see how this won’t be on the chopping block going forward.)
In any case, this is the one piece of the ACA that truly offends the right wingers. It actually is government paid health care, after all. I think Kilgore is right and that it’s not a given that these governors will accede to the federal law on this without a long drawn out battle.
As I said on the morning of the decision, there will be those who follow in the footsteps of their forebears: “no health care now, no health care tomorrow, no health care forevuh!” States’ rights were invented for people like this.
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