Liveblogging World War II: November 25, 1943
Noted for Your Morning Procrastination for November 25, 2013

The Coming Medical Care Divide: Timothy Egan on The South's (and Prairie's!) New Lost Cause: Live from the Roasterie XXXX: November 25, 2013

I do keep hearing that the Republican governors of America loathe Chief Justice John Roberts more than anybody else alive. He forced on them a dilemma: either alienate their bases by appearing to enthusiastically endorse implementing ObamaCare via the Medicaid expansion, or alienate their medical-care sectors by refusing to implement the Medicaid expansion and thus leaving a huge number of federal dollars on the sidewalk. They would much rather have not had that choice--have been required by law to implement the Medicaid expansion on pain of losing all Medicaid funds, and so been able to get the money while all the while whining about the infringement of their dignity...

Nevertheless, I would have expected a calculation of the financial fundamentals and simple human charity to have induced more to accept Medicaid expansion by now than in fact have...

Timothy Egan: The South’s New Lost Cause:

What is distressingly similar today is how the South [and the Prairie!] is once again committed to taking a backward path. By refusing to expand health care for the working poor through Medicaid, which is paid for by the federal government under Obamacare, most of the old Confederacy is committed to keeping millions of its own fellow citizens in poverty and poor health. They are dooming themselves, further, as the Left-Behind States. And they are doing it out of spite. Elsewhere, the expansion of Medicaid, the health care program for the poor, has been one of the few success stories of Obamacare. It may be too complicated for the one-dimensional Beltway press. Either that, or it doesn’t fit the narrative of failure.

But in the states that have embraced a program that reaches out to low-wage workers, almost 500,000 people have signed up for health care in less than two months time. This is good for business, good for state taxpayers (because the federal government is subsidizing the expansion) and can do much to lessen the collateral damages of poverty, from crime to poor diets. In Kentucky, which has bravely tried to buck the retrograde tide, Medicaid expansion is projected to create 17,000 jobs. In Washington, the state predicts 10,000 new jobs and savings of $300 million in the first 18 months of expansion.

Beyond Medicaid, the states that have diligently tried to make the private health care exchanges work are putting their regions on a path that will make them far more livable, easing the burden of crippling, uninsured medical bills--the leading cause of personal bankruptcy. And those states aren’t going to turn back the clock and revert to the bad old days, no matter how Republicans try to kill health care reform in the wake of the federal rollout. Many are refusing to accept Obama’s “fix” of allowing people to keep sketchy health care policies. If they follow the pattern of Massachusetts--where a mere 123 people enrolled in the first month of Romneycare, after which it gradually took off--the progressive states could end up with more than 95 percent of their residents insured.

What we could see, 10 years from now, is a Mason-Dixon line of health care. One side (with exceptions for conservative Midwest and mountain states) would be the insured North, a place where health care coverage was affordable and available to most people. On the other side would be the uninsured South, where health care for the poor would amount to treating charity cases in hospital emergency rooms.

Texas, where one in four people have no health care and Gov. Rick Perry proudly resists extending the Medicaid helping hand to the working poor, would be the leading backwater in this Dixie of Despair. In the 11 states of the old Confederacy, only Arkansas and Tennessee are now open to Medicaid expansion. The South, already the poorest region in the country, with all the attendant problems, would acquire another distinction -- a place where, if you were sick and earned just enough money that you didn’t qualify for traditional Medicare, you might face the current system’s version of a death panel.

The only good news is that a handful of political leaders down South have grasped the utter stupidity of refusing to help their own people, or even giving the state exchanges a chance. In this month’s recent special election for a congressional seat in a solidly Republican Louisiana district, a pragmatic businessman, Vance McAllister, beat a Tea Party candidate with the full Obama derangement syndrome. The winner said Obamacare was the law of the land and might as well be applied in Louisiana, the nation’s third poorest state. (It didn’t hurt that he had the backing of a “Duck Dynasty” star.) But most of the South is defiant -- their own Lost Cause for the 21st century.

Perhaps the most interesting thing is how the Republican Party is doubling down in its opposition to Medicaid expansion:

Ed Kilgore: The Pure Meanness Litmus Test:

Partly as a byproduct of conservative optimism about rolling back Obamacare and partly in conjunction with the Republican Governors Association meeting going on in Phoenix, there’s a lot of buzz right now about Medicaid expansion becoming (if it has not already become) a litmus test for conservative orthodoxy and also for acceptability as a 2016 presidential candidate. It’s no coincidence, of course, that one of the governors who did accept the expansion, Chris Christie, is the early MSM/Republican Establishment favorite for putting the Tea Folk back in their place and retaking the White House.

It’s worth accentuating that the Medicaid expansion issue has relatively little to do with the broader controversies over Obamacare. No one is being forced to drop private health insurance to enroll in Medicaid. No one can claim the president “lied” about Medicaid eligibility. The performance or non-performance of isn’t really an issue. The pace at which eligible folks sign up mainly just affects them. And there’s no “premium shock” associated with the Medicaid expansion.

And that is sort of why the issue makes the perfect ideological litmus test: opposing the expansion can’t be and isn’t being justified as a prudent objection to an unworkable program or as disruptive to the health care status quo. Yes, opponents whine about future fiscal obligations if and when the federal “super-match” that makes the expansion virtually free to participating states is allowed to expire (or is repealed), but that’s an almost abstract concern given the strong interest among Obamacare’s designers in increasing, not decreasing, the federal role in a more standardized Medicaid program.

So in many respects, states refusing the Medicaid expansion are doing so on grounds that they don’t want their own citizens to benefit from it. And since opposition has centered in the South, there’s not any real doubt a big motive has been a continuation of that region’s longstanding effort to—-choose your verb-—(a) reduce dependence on government among, or (b) keep down-—those people....

They are doing it out of spite. There are nicer ways of saying it, of course. A significant portion, probably even a majority, of conservative activists subscribe to the “tipping point” theory—reflected in Mitt Romney’s famous “47%” speech—that power-mad elites are deliberately using government benefits to create a permanent constituency of serfs among morally corrupted Americans—mostly minorities and young people—who won’t take responsibility for their own lives. Unlike resistance to the Obamacare exchanges, the resistance to the Medicaid expansion is a pretty clear expression not of fiscal concerns or alarm over the impact on insurance premiums or even of hostility to government involvement in health care, but a moral objection to expanded public health care coverage.

So yes, it will be a litmus test, especially when the 2016 presidential nominating contest heads south. If Chris Christie doesn’t “get” that fighting the Medicaid expansion is the latest front in the long civilizational battle of “decent” southern white folks to avoid being overwhelmed by the emboldenment of “those people” by manipulative Yankee elitists, then he’s hardly to be trusted with the presidential nomination of God’s own party. It’s a pure meanness litmus test, and it could be a lot more powerful than the misgivings about Romneycare in 2012.