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 2: The Role of Conservative Think Tanks
- Read Part 3: The Long-Term Costs and Economic Benefits
- Read Part 4: Alternative Models
Gaining perspective on the rollout of the Patient Protection and Affordable Care Act (ACA) can be difficult when we are embroiled in the day-to-day politicking that accompanies it. The media frenzy surrounding both the federal shutdown and the ACA’s chaotic online launch pushed all-important issues to the back burner. Among them is the fact that nearly 5 million impoverished adults are going to be left uninsured because their states have refused to expand Medicaid coverage.
This “Medicaid gap” leaves individuals who make too much to money to qualify for Medicaid, but not enough to receive health care subsidies, floating in an area where they aren’t eligible for insurance. As a report by the Kaiser Family points out, “Nearly half (47%) of uninsured people of color with incomes below the Medicaid expansion limit reside in the 21 states not moving forward with the expansion at this time.” It’s no coincidence that states like Alabama, Louisiana, and Texas, where racial disparity is already glaring, are leaving more ethnic minorities stranded than any other state. Currently, six out of 10 Blacks live in states not expanding Medicaid. While 38 percent of Mississippi’s population is Black, they account for more than half of the states’ poor and uninsured adults.
In addition to this, withholding Medicaid expansion presents an opportunity to further disenfranchise both women and the LGBTQ community. Pre-ACA, individuals with HIV had to have “a disabling AIDS diagnosis” in order to qualify for Medicaid coverage, and non-pregnant women did not typically qualify for Medicaid. These requirements are waived for states that accept Medicaid funding and expansion, so the ability to deny Medicaid presents yet another outlet through which hardline conservatives can propagate discrimination.
As the ACA is rolled out this month, an examination of strategies and talking points the Right has previously used against legislation which would have enfranchised women and minorities through means similar to current Medicaid expansion can help predict what we can expect from the Right.
The Equal Rights Amendment
The Equal Rights Amendment, (ERA) which on a whole guaranteed equal legal, political, and economic rights for women, was passed by the Carter administration. It then went to the states for ratification during the Reagan administration. The Right’s crusade against the amendment, led by Phyllis Schlafly, founder of the anti-feminist Eagle Forum, was a major factor in preventing the ratification. The vote eventually fell three states short of approval.
In her push against the amendment, Schlafly claimed that by discontinuing to give the “weaker sex” privilege, the ERA would end “civilization as we know it” and was quick to claim that the “ERA means abortion funding, means homosexual privileges, means whatever else.”
Though the landscape has shifted, the arguments remain the same. Members of the Religious Right are more often than not mobilized by their fear that legislative measures threaten family foundations. Schlafly’s arguments proved effective during the Carter and Reagan Administrations, and these same arguments now put a holistic rollout of Medicaid expansion in jeopardy. Her “in defense of the traditional family” argument is now utilized by conservatives against Medicaid’s expansions attempts to enfranchise members of non-traditional families (as defined by the Right).
Kevin Kane of the conservative think-tank Pelican Institute asserted in a post titled “The Trouble With Medicaid,” that “these programs and their incentives have contributed to the demise of marriage and the traditional family unit, to the detriment of the children that are raised in unstable environments, lacking the demonstrable benefits of a two-parent family,” adding that the “social costs” outweigh any benefits afforded by the expansion. Along these same lines, Terence P. Jeffrey, editor in chief at CNS News and former executive director of the American Cause, goes as far as to claim that Medicaid expansion “rewards people who don’t marry, don’t work and don’t take care of their own children. It punishes people who do marry, work hard and take care of their own children.”
Both men are referring, of course, to a traditional family, completely rejecting the fact that the family has evolved far past a man, a woman, and her children, and refusing to acknowledge that such families deserve just as much support and protection.
Clinton Administration Health Care Reform
The demise of the Clinton Administration’s plan for universal health care is widely attributed to William Kristol and the Project for the Republican Future. Chairman of the organization at the time, Kristol distributed a memo to Republicans warning that success of the reform would “signal a rebirth of centralized welfare-state policy at the very moment we have begun rolling back that idea in other areas. And, not least, it would destroy the present breadth and quality of the American health care system, still the world’s finest. On grounds of national policy alone, the plan should not be amended; it should be erased.” Without context, it would be difficult to discern whether this comment regarded Clinton-era healthcare reform or Obama-era healthcare reform.
The memo, which can be read in its entirety here, outlines strategies and talking points that can be used against the Clinton administration’s push for universal health care. Fast-forward two decades, and the “memo” against the ACA comes in the form of a playbook. Distributed to all members of the Republican Party, it’s full of across-the-board strategies for attacking the Affordable Care Act (a.k.a. Obamacare). Talking points around Medicaid include claims that the expansion of coverage to childless adults will end up “diminishing resources for vulnerable populations.” Ed Haislmaier of the Heritage Foundation attacked childless adults in this context, stating they “are not vulnerable poor people” and suggested that if they had full time jobs, they would be covered by health insurance subsidies. He dismissed their issues as “not really healthcare issues,” but economic issues. Such rhetoric is a testament to both the strong ideological underpinnings of the resulting health care gap, and brings forth concern that the gap will perpetuate bias against anyone who makes the choice to not have children.
History proves that progress towards comprehensive healthcare for non-traditional families (as defined by the Right), the poor, and minorities can be greatly hindered by the Right. Their mobilization of financial and moral arguments have proven to be effective and are advancing with fervor, as evidenced most recently by the attacks on reproductive health funded by the Koch Brothers and a libertarian driven resurgence of neo-confederacy.
Key players of the Right have been able to influence the social stances of moderate Republicans by appealing to both their economic sensibilities and a strong attachment to the (distorted) ideas of “liberty” and “traditional family.” This is becoming ever more pervasive and dangerous in our current political climate as partisan divisions grow wider.
As we look towards both the rollout of the ACA and the 2014 and 2016 elections, the closing paragraph of Kristol’s memo warrants serious consideration. In it, he calls for the complete political defeat of the Clinton healthcare proposal, asserting that the “rejection by Congress and the public would be a monumental setback for the president; and an incontestable piece of evidence that Democratic welfare-state liberalism remains firmly in retreat. Subsequent replacement of the Clinton scheme by a set of ever-more ambitious, free-market initiatives would make the coming year’s health policy debate a watershed in the resurgence of a newly bold and principled Republican politics.” These “newly bold and principled Republican politics” are on the rise again, and though the issues may slightly change, the strategies remain the same.