This week, the interns at PRA are posting a series of blog posts examining the recent right-wing opposition to Medicaid expansion. In June 2012, The Supreme Court found the expansion of Medicaid an unconstitutional coercion of states’ rights, leaving the decision firmly in the hands of the states. Medicaid expansion is set to go in effect in this month, and as of now, only 25 states and Washington, D.C., are moving forward with the expansion. Expanding Medicaid is a necessary provision of the Affordable Care Act, and the 25 remaining states are ensuring that large portions of the population will still have no access to affordable healthcare. These blogs seek to explain both where opposition to Medicaid expansion originates, and why it might be in the interest of the politicians on the Right to accept the proposed expansion.
- Read Part 1: Using Clinton-Era Talking Points Against Families & Minorities
- Read Part 2: The Role of Conservative Think Tanks
- Read Part 3: Long-Term Costs and Economic Benefits
The success stories of Massachusetts and California provide examples of how the Medicaid expansion can work on its own terms. As other states begin to reap the benefits of increased Medicaid coverage, stories such as these may convince other state legislatures and governors to expand Medicaid. But for those who have chosen to opt out of the expansion, increased Medicaid coverage is not a matter of trepidation.
So what about the states governed by people who believe that compliance with the Obama administration is the political equivalent of a cardinal sin? Gov. Rick Perry (TX) stated early in 2013 that “Texas will not be held hostage by the Obama administration’s attempt to force us into the fool’s errand of adding more than a million Texans to a broken system.” In choosing no system over a so-called “broken system”, Gov. Perry has doomed Texas to the largest coverage gap in the country. One million of the 5.2 million people who will not have health insurance options under the Affordable Care Act (ACA) live in Texas. Along similar lines, the governors of Alabama and Georgia have both said, in spite of the 100% coverage the expansion will provide, that it is simply something they cannot afford.
Statements given by Perry and other governors cite financial concerns as the primary reason for opting out of the expansion. As we have discussed in parts 1,2, and 3 of this series, these concerns are only substantiated by a number of incomplete, misinformed, and misleading studies about the effects of Medicaid Expansion. This is because evidence to suggest financial problems with the expansion are the result of an aversion to the Obama administration and Obamacare, when logically and financially sound evidence should inform concerns, not be informed by them.
The influx of so many federal dollars towards healthcare, however, has proven too tantalizing for some conservatives. Stuck between a rock and a hard place, some states have discerned a way to benefit from the Medicaid expansion while continuing to adhere to conservative ideologies.
While Gov. Perry has chosen the path of victimhood under the aegis of Obamacare, the Arkansas legislature had already taken a proactive step towards securing health care for its citizens. In February 2013, two months before Gov. Perry took his hardline stance against Medicaid expansion, the federal government approved an alternative model to Medicaid expansion for Arkansans. Using a “Healthcare Independence” 1115 waiver application, Arkansas has been approved to use the money they are receiving for Medicaid expansion to buy private health insurance for about 200,000 Arkansans. In April, the Arkansas legislature signed their alternative model into law, and on September 27 the Medicaid and Medicare services notified state officials they had approved the plan. Iowa is also waiting for federal approval on a similar plan, also using the 1115 waiver, and Indiana, Oklahoma, and Pennsylvania are considering similar models.
This display of the federal government’s flexibility insures that Arkansans receive health care. It also shows that much of the rhetoric claiming the federal government’s implementation of Medicaid is holding states “hostage” bears little resemblance to reality. Mississippi Gov. Phil Bryant was quoted in January saying, “I would rather pay extra to Blue Cross [to help cover uncompensated costs for the uninsured], rather than have to raise taxes to have to pay for additional Medicaid recipients.” But in June, the Mississippi Legislature, led by Gov. Bryant, blocked plans to expand Medicaid and the House Democrats’ proposal for an alternative model similar to the one in Arkansas, making Gov. Bryant’s remarks on paying extra into Blue Cross seem off the cuff and inflammatory, rather than thoughtful or prescient.
In a way, the alternative model in Arkansas is a victory for conservatives, a less spiteful and facetious “victory” than the ones Gov. Perry and his ilk are claiming. It pays lip-service to those who believe that Obamacare support is a political sin. According to the language of the 1115 waiver, states like Arkansas can now claim “healthcare independence.” Words such as “alternative” and “independence”, however, serve to cloak a stealth victory for the Obama administration in a move akin to a parent giving their child a dollar so they can “pay” for a candy bar themselves.
Obamacare’s main goal, according to an ACA website, is to “give more Americans access to affordable, quality health insurance and to reduce the growth in health care spending in the US.” The law’s main tenet is not that everyone have Obamacare (people who already have quality healthcare fall outside the ACA’s scope anyway), but for everyone to have healthcare. Not only does Arkansas’ alternative model fall in line with Obamacare’s primary tenet, but it would also be impossible to implement without federal dollars. In ten years’ time, hardline conservatives may tout their alternative plan as a triumph of state autonomy, and as a victorious rejection of “big government.” Hopefully, a more balanced reflection will recognize the flexibility of the Affordable Care Act and the administrations’ dedication to health care reform over petty ideological differences.
Medicaid Expansion: Looking Forward and Thinking Back
Over the past week we have explored the discussion surrounding Medicaid expansion as stipulated under the Affordable Care Act. We have looked at the history of Medicaid, the conservative rhetoric used to vilify the rollout, the effectiveness of the program in the face of conservatives’ misleading apprehensions, and the way the expansion has morphed to placate conservatives while at the same time providing more Americans with health care.
But how does all this bode for the future of the Medicaid expansion? As January 2014 comes and goes, the conversation is going to change as the expansion is put into effect and the apprehensions of conservatives are put to the test. And while the conversation will inevitably change as theories surrounding the expansion become praxis, we can already see the way the Far Right will maneuver to combat the ACA and Medicaid expansion in the new year.
No doubt conservative think tanks will continue to crank out misleading and misinformed studies to scare up opposition to the Medicaid expansion. Perhaps the best defense against proving the ineffectiveness of the expansion will continue to be governors’ and legislators’ outright refusal to participate in the program in an attempt to tank it and to appeal to an increasingly influential, if extraordinarily small, constituency of voters.
Conservative attempts to tank Medicaid span far past the implications of a new healthcare system. That is to say, this push against Medicaid expansion is not only coming out of both the desire to damage President Obama and a desire to keep control out of the hands of a significant portion of the population. Medicaid poses a threat to elite White men who are in the top economic brackets, just like Clinton’s Omnibus Reconciliation Act, Johnson’s Voting Rights Act, Carter’s Equal Rights Act, and Roosevelt’s New Deal did. When liberal policies that aim to empower the oppressed make ground in the legislative arena, conservatives see this as detrimental to their own power. Thus, the struggle to maintain power by strongly opposing initiatives comes from at least two distinct angles – attempts to tarnish a Democratic presidents name in order to lessen chances of another Democrat being elected to office and attempts to ruin the actual implementation in order to ensure that those who support the liberal cause remain disenfranchised and far less able to influence politics.
In a recent blog post, the Heritage Foundation assured its subscribers that the movement against Obamacare was just beginning, “We’ve always had alternatives [to Obamacare], but our critics weren’t ready to listen. Now, the disastrous rollout of Obamacare has a lot of people asking for alternatives to government-run health care. And conservatives are ready.” Reading the report, which promotes the repeal of Obamacare and the implementation of “patient-centered, market-based” health care that bears more than a passing resemblance to pre-Obamacare health care, it becomes more evident how conservatives are changing the conversation.
Now that Obamacare is the incumbent healthcare system, the “alternative” that people weren’t ready for is the old system, granted with a few bells and whistles attached. This sort of rhetorical subterfuge, hiding the fact that the conservative “alternative” is little more than a rehashing of an outdated system that left millions in the U.S. without healthcare, will likely be folded in to what is shaping up to be an intricate gambit to create a good bid for the Republicans in 2016.
In the wake of the repeal of section 4(b) of the Voting Rights Act, the discussion surrounding the Medicaid expansion becomes part of a larger trend to disenfranchise a voting base that conservatives have increasingly alienated. But the refusal of many red states to expand Medicaid comes with more human collateral than the repeal of a section of the VRA.
As we have discussed, the states that are not expanding Medicaid are also the states that have the lowest Medicaid income gaps. Again, this gap affects a voter base that conservatives and the Far Right are continually trying to disenfranchise. Ethnic minorities are disproportionately affected by the gap.
The alternative models to the expansion may bode well for the availability of healthcare in the U.S., but at the same time they do play into the conservatives’ subversion of the Obama administration and leftist ideologies. In this way, these alternative models are more a moral than an ideological victory. The alternative models are, of course, better than nothing, and this moral victory should not be discounted, but we must nevertheless remain aware of the way conservatives will spin the success of these models.
As the Medicaid expansion adds successes such as the ones in California and Massachusetts, the Far Right and conservatives will continue to promote ideological ballast to bog down these successes. The 2013 government shutdown, the repeal of section 4(b) of the Voting Rights Act, and now the refusal to expand Medicaid, are part of a larger gambit to create a conversation in which the GOP can pretend to clean up its own messes to make themselves look noble.