Live from the Roasterie: as I already wrote this morning, at the state level Medicaid expansion is a total no-brainer: your citizens are already paying the taxes to pay for other states Medicaid expansion, and so the choice is either (i) pay the taxes and get none of the benefits, or (ii) pay the taxes and get your share of the benefits. Option (i) makes sense only if you can somehow convince people that Medicaid spending is evil. Since the claim that Medicaid is useless was never and is not credible, that leaves doubling-down on race and class hatred--of ghetto-dwellers, of the working poor, and of doctors and hospitals that treat Medicaid patients as part of their practice and would like to be paid something for it.
And, of course, in reality it is not big-city hospitals that treat Black people that are going to be the first to close without Medicaid expansion, it's rural hospitals that treat white people:
: This GOP Governor [Sam Brownback]'s Comments About the Poor Are Incredibly Revealing: "The hospital industry has been begging lawmakers to take the federal dollars...
...citing, among other things, the recently announced closing of a rural facility, Mercy Hospital of Independence, in the southeastern part of the state. In response, some Republican lawmakers conceded that maybe it was time for Kansas to join the program. Brownback is having none of it... expanding Medicaid would be ‘morally reprehensible’ because it would help ‘able-bodied adults… who choose not to work' and would send money to ‘big city hospitals.’...
Below are some key sections of the text, along with annotations from The Huffington Post to provide some context that the letter leaves out....
Today, as hospitals nationwide face the ramifications of Obamacare, Democrats are clamoring for an antidote to their self-inflicted wound. They think Medicaid Expansion is the solution. They are wrong...
Contrary to what the letter claims, the 'wound' to the Affordable Care Act--and, by extension, the hospitals now struggling with lost revenue--was not inflicted by Democrats. It was inflicted by the Supreme Court, and then by Republican officials like Brownback.... Reimbursements from newly insured Medicaid beneficiaries would offset cuts to other federal programs.... But in 2012, the court gave states more leeway to opt out of the Medicaid expansion, and now, Republican officials like Brownback are using that leeway to turn down the money--even though the other cuts are still taking place. Some hospitals have margins big enough to cover these losses. But some hospitals serving large numbers of uninsured patients do not...
Liberals know the political toxicity of Obamacare, so they’ve continued their call for government-run healthcare under the name of Medicaid Expansion.
‘Toxicity’ is a strong word for a law that, according to the polls, has nearly as many supporters as opponents--and which contains features that, with only a few exceptions, are wildly popular.... Meanwhile, it's not just liberals calling to expand Medicaid. Plenty of conservatives are, too--because, notwithstanding their general feelings about the Affordable Care Act, they realize that expanded programs can boost state economies and help needy residents get affordable health care. In Arkansas and Michigan, for example, conservative officials agreed to compromise measures that allowed federal money to start flowing.
This... primary objection is a moral one: Medicaid Expansion creates new entitlements for able-bodied adults without dependents, prioritizing those who choose not to work before intellectually, developmentally, and physically disabled, the frail and elderly, and those struggling with mental health issues. This isn’t just bad policy, this is morally reprehensible.
Put aside the stuff about ‘able-bodied adults’ for just a moment, and focus on that statement about protecting the mentally ill. It is baffling. As Harold Pollack, a professor of social work at the University of Chicago and leading expert on Medicaid, noted recently in the Washington Post, expanding the program would dramatically increase access to mental health treatments.... States with higher Medicaid enrollment can spend less on other programs that directly or indirectly subsidize care for the uninsured. The math would appear to work out pretty well for Kansas: A 2012 estimate by Urban Institute researchers and published by the Henry J. Kaiser Family Foundation projected that, during the first 10 years of the Affordable Care Act’s implementation, states' extra spending would add up to less than 1 percent of total general fund expenditures. That’s not even taking into account the fact that the extra Medicaid money would also spur economic growth, boosting tax revenues. In short, there’s no reason to think expanding Medicaid would seriously threaten support for the disabled and other vulnerable groups. If anything, the opposite is true.
...this Obamacare ruse funnels money to big city hospitals, creates a new entitlement class, and fails to rightly prioritize service for disabled citizens. Governor Brownback will maintain his commitment to provide care to vulnerable Kansans before able-bodied adults.
The letter’s most misleading claim, which appears several times, is also its most familiar one. It's the idea that people who would receive Medicaid are primarily ‘able-bodied adults’ who ‘choose not to work.’... Two-thirds of expected beneficiaries live in households where somebody works, and slightly more than half have jobs of their own... in low-wage or part-time jobs, frequently for small businesses that don’t offer coverage.... Does Medicaid end up subsidizing some people who could find employment, but choose not to do so? Of course. All social welfare programs do. But, by and large, the expansion is going to help individuals and families where somebody is working--and frequently, working very hard.... It remains to be seen how Brownback's rhetoric plays in Kansas. The state has never been particularly generous towards the poor. Its existing Medicaid program is among the stingiest in the country, and it's not like voters there were clamoring for a change before the prospect of expanded Medicaid arose. But regardless of the letter's political impact in Kansas, or even beyond, it's a reminder of the way many Republicans still feel about the poor.
