“Grappling With Their Shortsighted Rejection”: The Tough Politics Of Medicaid For Republicans
In the world of Republican politics, there is no surer bet than opposing ObamaCare. But conservative obstruction to the health care overhaul may finally be catching up with a handful of Republican governors running for re-election. Their rejection of ObamaCare’s expansion of Medicaid — the federal health assistance program for the poor and disabled — has been them losing both the argument and voters.
Princeton political scientist Sam Wang recently published an analysis of polling data from this year’s gubernatorial races. It found that Republican incumbents who resisted ObamaCare’s Medicaid expansion — including Wisconsin’s Scott Walker, Pennsylvania’s Tom Corbett, and Kansas’ Sam Brownback — are in much tighter races than those who accepted it. “Republican governors who bucked their party’s stance and accepted the policy are faring better with voters — in these races, an average of 8.5 percentage points better,” Wang discovered.
This shouldn’t be surprising. Setting aside the incendiary politics surrounding ObamaCare and its alleged freedom-killing agenda, the simple truth is that Republican governors have blocked health insurance for nearly six million citizens. And they’ve done so despite the fact that under ObamaCare, the federal government covers all the cost of expanding Medicaid for the next six years, and at least 90 percent of the cost in 2020 and beyond.
Why have Republican governors spurned this incredibly good deal? Their ostensible justification has been disbelief that the federal government would hold up its end of the bargain, leaving states to pick up the tab.
But researchers at the Urban Institute threw cold water on this argument in a study last month. They found that the federal government has almost never reduced funding to the states for Medicaid. In fact, it has not done so since 1981, when President Reagan and Congress imposed a temporary funding cut.
Indeed, Congress has been far more likely to increase funding for state Medicaid programs. It has done so twice in recent memory — in 1997 and in 2005 — boosting state funding even while making other cuts to the program.
The sanctity of the federal commitment to Medicaid has only grown in recent years. As evidence of federal faint-heartedness, conservatives point to an administration proposal floated during 2011 budget negotiations that would have reduced federal Medicaid funding to the states.
But this bad idea was dropped after the states got newfound bargaining power from the Supreme Court’s 2012 decision making the Medicaid expansion entirely voluntary. With the expansion now optional, the administration can ill afford to weaken the financial carrot for red states to buy in. This has also made the administration agreeable to some conservative twists on traditional Medicaid, like using public dollars to enroll people in private health plans in Arkansas and Iowa.
The Urban Institute also quantified how much intransigent red states are losing by resisting ObamaCare. They’re turning down $400 billion in free federal money over 10 years. They will have missed out on over 172,000 new jobs in 2015 alone. And they’ve cost their hospitals $168 million, enough to completely offset ObamaCare’s reimbursement cuts to hospitals for Medicare and Medicaid.
And, of course, these states have also frozen themselves at pre-ObamaCare rates of high uninsurance. “While the number of uninsured in other states fell by 38 percent since September 2013,” the researchers explain, “non-expanding states experienced a decline of just 9 percent.”
As the midterm elections approach, Republican candidates are discovering that the politics around health care reform are becoming unexpectedly complicated. Trailing badly in the polls, Gov. Corbett announced last month that Pennsylvania will expand its Medicaid program. In states that have already expanded their programs, pro-repeal conservative candidates are stumbling to explain how they would handle new Medicaid enrollees.
But this is what happens when you engage with the actual policy implications of health care reform. Conservatives can whip up fear and hostility over an abstract big-government monolith called ObamaCare. But the actual programs contained therein (like expanding public health insurance for the poor) tend to be pretty appealing to voters.
As their arguments are rendered hollow, obstructionist Republicans are paying the electoral price for thwarting these types of programs. When they picked a fight against expanding Medicaid, conservatives chose the wrong bulwark for massive resistance against national health care reform.
By: Joel Dodge, The Week, September 9, 2014
“Widening Disparities”: Maine Props Up ‘Two Americas’ With No Medicaid Expansion
The Affordable Care Act, as originally passed, holds tremendous promise to decrease health care costs and increase insurance coverage rates across rural states like Maine. But federal court opinions and repeated vetoes of Medicaid expansion are putting all that into jeopardy. Already, data is pointing to widening disparities between the states embracing health reform and those that have resisted — in the numbers of uninsured, in new health care jobs and in the finances of local hospitals.
Historically, the United States has maintained the highest health spending in the world, but it still had lower life expectancies and the highest rates of infant mortality in the developed world. Health costs have sucked up 18 percent of our gross domestic product, leaching out wage gains and damaging America’s global competitiveness.
These factors drove Congress and the president to enact health care reform. Since then, despite the fact that health care utilization typically increases as the economy recovers from recession, health care cost growth has been held in check and health economists increasingly agree that this is due to the structural reforms initiated by the ACA.
And, with federal subsidies and Medicaid expansion to help cover the working poor, the number of people who are uninsured in the country is going down. These are promising trends, but die-hard reform opponents continue to work to reverse them. Every recalcitrant governor, every contentious court decision impedes health reform from realizing its full potential, despite its proven success to date.
There are two Americas. One is prosperous, long-lived and healthy. The second comprises the working poor who are short-lived, disabled early and beset by chronic illnesses that could have been prevented — diabetes, heart failure, pulmonary disease. Those in this second America are people who have a job — maybe two — but do not earn enough to make ends meet.
We make special provisions for some of the most vulnerable in this group — children, the elderly and disabled — but millions of hard-working Americans fall through the gaps. And unfortunately, the ranks of America’s working poor are increasing, not shrinking.
An American born in one of our rural counties is likely to live a shorter life than a person in Algeria or Bangladesh. Meanwhile, Americans who live in prosperous urban regions have life expectancies that rival the healthiest places in the world. This disparity exists, and it takes money. It costs our economy, through lost worker productivity and the high price of treating people in emergency rooms when they cannot afford less expensive preventive care.
As designed, health reform aimed to erase health disparities. It pumped money into making affordable health care available to Americans in poorer, more rural states like Maine. It offered good jobs and billions in economic impact while improving the quality of care to all Americans wherever they live, whatever their income. It directed money to cost-effective primary care and dedicated scholarship funds to increase the number of doctors in rural and underserved areas, like much of Maine.
The New York Times recently reported that state-level refusal to expand Medicaid combined with the recent court ruling jeopardizing subsidies to residents of states on the federal exchange threaten to undo the national reform and create a state-by-state patchwork. This would effectively maintain the two Americas. The states that declined to expand Medicaid or design state exchanges are mostly the poorer, less healthy states. Right now, Maine is on this list.
Gov. Paul LePage has vetoed majority votes to expand Medicaid five times. If we continue in this direction, 12 percent of Mainers will continue to be uninsured while 96 percent of residents in nearby Massachusetts are insured.
Politics threaten to block health reform from fulfilling its promise: to bridge the yawning gap in health and economic potential between the two Americas. Partisan politics shouldn’t block Maine from reaping the benefits of health reform — both in better health outcomes and in expanded economic opportunity.
By: Christy Daggett, Policy Analyst, The Maine Center for Economic Policy; Published in The Bangor Daily News, August 19, 2014
“24 Health-Care Scandals”: Legislators Who Block Medicaid Expansion Are Stiffing Veterans Out Of Health Care, And Stiffing Workers Out Of Jobs
The scandal over long wait times for veterans in the Department of Veterans Affairs health system has grabbed a lot of headlines and elicited a lot of righteous anger — as it should. America’s veterans deserve so much better.
But as Ezra Klein pointed out in a piece in Vox, there’s another health care scandal that also deserves its share of righteous anger, and it also has a big impact on veterans with health care needs: the self-destructive refusal of lawmakers in 20-plus states to accept federal funds to expand their Medicaid programs.
Klein cataloged “24 health-care scandals that critics of the VA should also be furious about” (that is, the 24 states that have rejected the Medicaid expansion). Thanks to lawmakers’ knee-jerk opposition to expanding health coverage in those states, there are huge numbers of uninsured veterans who should be eligible for coverage, but aren’t: 41,200 veterans in Florida, 24,900 in Georgia, 48,900 in Texas… and the list goes on.
All in all, about 250,000 uninsured veterans are getting stiffed out of eligibility for health coverage by lawmakers who have blocked Medicaid expansion, according to Pew’s Stateline. As it turns out, those lawmakers are also stiffing their own states out of economy-boosting jobs — health care jobs that are overwhelmingly good-paying jobs. Medicaid expansion would create thousands more of these jobs.
Virginia, where Medicaid expansion still hangs in limbo, is a perfect example. According to a report from Chmura Economics & Analytics, Medicaid expansion would create an average of over 30,000 jobs annually in Virginia, including more than 15,000 jobs in the state’s health care sector. An analysis of data on projected job openings and wage levels underscores that these will be good-paying, economy-boosting jobs.
For a single adult in Virginia, less than half of all projected job openings statewide pay above a living wage ($18.59/hour, according to the 2013 Virginia Job Gap Study). However, three out of five health care job openings and close to nine out of 10 health practitioner and technical job openings do.
For a household with two working adults and two children, while less than two out of five projected job openings in Virginia pay median wages above a living wage ($21.99/hour per worker), half of health care job openings and more than seven out of 10 health practitioner and technical job openings do.
Or look at Maine, where Gov. Paul LePage vetoed a bipartisan Medicaid expansion plan passed by the Maine Legislature earlier this year, and too few Republican legislators were willing to break ranks with the Governor to override his veto. There, Medicaid expansion would create over 4,000 jobs by 2016, including more than 2,000 jobs in Maine’s health care sector. As with Virginia, health care jobs beat statewide wage levels in Maine by wide margins.
For a single adult, less than half of all projected job openings in Maine pay above a living wage ($15.18/hour, according to the 2013 Maine Job Gap Study). But two-thirds of health care job openings and almost nine out of 10 health practitioner and technical job openings do. For a household with two working adults and two children, while barely one-third of projected job openings in Maine pay above a living wage ($18.87/hour per worker), almost three-fifths of health care job openings and more than four out of five health practitioner and technical job openings do.
Health care jobs are also overwhelmingly higher-wage jobs in states like Montana and Idaho. But all these states, along with 20 others, have been missing out on these economy-boosting jobs because their legislatures or governors have rejected Medicaid expansion.
State lawmakers who continue to block Medicaid expansion do so at their own peril — both morally and electorally. Because you can only stiff your own constituents — including low-income, uninsured veterans — out of both access to health care and good-paying, economy-boosting jobs for so long before it catches up with you.
Want to really do something to help veterans get access to the health care they need and create good-paying jobs for your constituents at the same time? Two words: expand Medicaid.
By: LeeAnn Hall, Executive Director, The Alliance For A Just Society; The Huffington Post Blog, August 6, 2014
“Memo To GOP”: The War Over Big Government Health Care Is Over, And You Lost
The federal government has released new data on Medicaid enrollment showing that with the implementation of the Affordable Care Act, six million Americans were added to the program’s rolls. That’s six million low-income people who now have health coverage, who can see a doctor when they need to and who don’t have to worry about whether an accident or an illness will send them spiraling into utter financial ruin.
The numbers reveal something else, too, something that should horrify conservatives: we’re well on our way to health-care socialism.
Okay, that’s an exaggeration. But only a slight one. And at a time when the press is realizing that Republicans are losing their taste for anti-Obamacare bloviating (more on that in a moment), it shows that Bill Kristol’s nightmare has nearly come true.
Back in 1993, Kristol wrote Republicans an enormously influential memo advising that the best approach to Bill Clinton’s health reform plan was not to do everything they could to kill it outright. If any plan managed to pass, he warned, “it will re-legitimize middle-class dependence for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.”
Now let’s look at where we are today. Prior to ACA implementation, there were just under 59 million people enrolled in Medicaid and CHIP, the program that covers poor children. States that accepted the ACA’s expansion of Medicaid signed up a total of 5.2 million new people. The states that rejected the expansion signed up an additional 800,000; these are “woodwork” enrollees, people who were already eligible under their state’s (often absurdly restrictive) rules, but came out of the woodwork to sign up because of all the attention to health care. Add them in, and there are now 64 million Americans on Medicaid and CHIP.
On top of that, there are now over 52 million seniors on Medicare. There are another 9 million veterans enrolled in the Veterans Health Service.
That’s a total of 125 million Americans getting their insurance from the federal government (or, in the case of Medicaid, a federal-state program). The current U.S. population is 318 million. That means that 39 percent of us, or just under two out of every five Americans, are recipients of government health insurance.
As a liberal, of course, I believe that’s a good thing, though just how good varies from program to program (I’ve spent enough time fighting with private insurance companies to wish I could be insured by the government). Conservatives, on the other hand, view this as a disaster. What they’ve only partly come to terms with is the fact that it’s going to be almost impossible for them to do anything about it.
It’s true that Republicans appear to have realized that while the ACA remains unpopular, the idea of repealing it is even less popular. Which is why, as the November election approaches, they’ve almost stopped trying to elevate the issue. As Sam Baker points out, Republicans passed on the opportunity to use the confirmation of Sylvia Burwell to be HHS secretary as a forum to relitigate the law, and the bills circulating around the Hill on health care are now more likely to be small-bore fixes. Notes Baker: “Anyone who’s been around Capitol Hill and health care for the past four years can see it — the anti-Obamacare fire just isn’t burning as hot as it used to.”
Beyond that, as this blog has documented, multiple Republican Senate candidates are now mouthing support for Obamacare’s general goals and have essentially been reduced to gibberish when trying to explain their “repeal and replace” stance.
But the story is bigger than all of this. Republicans may have to accept that while we may not have the single-payer system liberals want, government still dominates American health care, and that isn’t going to change.
It isn’t just that Republicans could stage another fifty ACA repeal votes in the House and accomplish just as little as the last 50 repeal votes did. Rather, it’s that even if Republicans took back the White House and both houses of Congress, moving people off their government insurance would be next to impossible.
One of the most important lessons of the last 20 years of health reform is this: people fear change. That’s what the Clinton administration found out when their attempt at reform crashed and burned, in large part because the Clinton plan would have meant a change in coverage for most Americans. The Obama administration took that lesson to heart in creating its plan, which was designed to give coverage to people who lacked it but offer only new protections to those who already had insurance. That was also the reason for the false but endlessly repeated “if you like your insurance, you can keep it” assurances — they knew that if most Americans, particularly those with somewhat-secure employer plans, thought they’d have to endure some kind of change, then they’d once again be gripped by fear.
Any Republican plan to unwind the ACA is going to run headlong into people’s fear of change and be stopped in its tracks. Are you going to push 64 million Medicaid and CHIP recipients off their current insurance and onto private plans? Are you going to move away from employer-provided coverage? Are you going to privatize Medicare?
Perhaps, given the right circumstances, Republicans could overcome that fear. But I wouldn’t bet on them finding a way to do it.
By: Paul Waldman, The Plum Line; The Washington Post, June 5, 2014
“If You Vote For A Republican…Beware”: Republican Governors Show Their True Colors Turning Down Billions In Medicaid Expansion
In a 2012 decision, the Supreme Court ruled that states could decide to take the Medicaid expansion or not. In a purely political, but predictable move, Republican governor after Republican governor chose to say no to Medicaid expansion for their states even though their community hospitals are bursting at the seams.
Why would any elected official turn down free health care dollars for its citizens? These 24 Republican governors would prefer to say no to billions of federal dollars that would provide healthcare coverage for millions of destitute folks, than take funds from the Obama administration. They claim their states could not afford the expansions. The truth is that the federal government pays 100 percent of the cost the first three years and then at least 90 percent thereafter. Hate truly is stronger than compassion in the GOP and it is costing the party their logic, reason and good business sense. When you turn down health care for millions of citizens, billions of dollars and job creation out of spite, you are not representing the best interests of your constituents.
Many Republicans say they don’t think the government should be involved in keeping its citizens healthy through a government-provided healthcare system. My question is why is it OK for great government health care to be provided to these elected Republicans but it’s not OK to provide for our American people?
Rick Perry, governor of Texas, turned down the Medicaid expansion that would have created 200,000 new jobs in addition to insuring millions of people. As a result of his selfish ideology, Texas will lose more than $9 billion.
In Florida, the healthcare company Columbia/HCA, was fined $1.7 billion for Medicare fraud while Rick Scott, prior to being governor, was CEO. Now Scott doesn’t want to let Florida’s citizens receive the benefits from the Medicaid expansion. Florida will lose $5 billion.
If Louisiana accepted the ACA provisions and expanded Medicaid, 240,000 people would be eligible for affordable care, yet Governor Bobby Jindal refused.
Gov. Mary Fallin and legislative leaders also rejected the expansion of Medicaid coverage for approximately 175,000 uninsured Oklahomans leaving the state with no viable overall healthcare plan.
In Pennsylvania, Gov. Corbett’s decision not to accept the expansion will leave $500 million in federal funds on the table in 2014. These funds could provide health care for 500,000 people, a financial boost to hospitals and local healthcare providers, and create upwards of 35,000 jobs.
Likewise, Governor Christi of New Jersey vetoed a bill that would permanently establish the Medicaid expansion.
By 2022, Georgia, Missouri, North Carolina and Virginia will all lose more than $2 billion each.
Expanding Medicaid coverage costs less than 1 percent of the state budgets on average, while not accepting the funds are leading to state budget shortfalls and health facilities closures.
While the Republicans are quick to send our military into harm’s way, they are less eager to take care of them when they return home.
About 1.3 million veterans are uninsured nationwide. According to a report by Pew, approximately 258,600 of these veterans are living below the poverty line in states refusing to expand Medicaid. Without veteran’s benefits and with incomes too low to qualify for subsidies to use state exchanges, these veterans are left without affordable coverage options.
State governors owe the best health care available to their citizens whether veterans, indigent or just the sick. But, that isn’t what these Republican governors are doing. They are placing their political ideology over their citizens’ health.
The states with the most uninsured and the poorest people are the same states refusing to take federal funds to help their people. Instead of embracing the Medicaid expansion, they are shunning it as if it was a plague. While taxpayers in all states fund the Medicaid expansion, only people in half the states are reaping the advantages of those tax dollars, jobs and medical benefits — the states with Democratic governors.
Democratic Maryland Gov. Martin O’Malley, on the day after the Affordable Care Act of 2010 was signed into law, appointed a task force to prepare his state to accept more Medicaid money and establish rules on how it would be spent. Its program will offer 300 insurance options provided by 12 private insurance companies and nine managed-care systems. These aren’t government programs but private ones — just like the coverage carried today by millions of Americans.
Governor Beshear (D) of Kentucky has made the Medicaid expansion a key component of his administration. He quickly accepted ACA realizing that the 640,000 uninsured Kentuckians would be able to get insurance through Medicaid expansion and coverage through the health benefit exchanges.
Every American citizen over the voting age of 18 has the right to vote for a Democrat, a Republican or someone from one of the smaller parties. But, if you vote for a Republican… beware of what you might lose as a result.
By: Gerry Myers, CEO, President and Co-founder of Advisory Link; The Huffington Post Blog, May 26, 2014
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