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Hullabaloo


Friday, June 29, 2012

 
The liberal jewel in the ACA crown: Medicaid

by digby

One of the reasons I resist getting all giddy about every Obamacare victory is because I know it's never going to end. They will be fighting this long after I am dead. (After all, they're still trying to end Social Security after 75 years). So everyone should just hunker down and assume that the battle is ongoing. A "win" is never final. In fact, it's usually the beginning.

But after reading reams of analysis over the past 24 hours I do think it's worth pointing out again that this case was not joined by any of the Medical Industrial Complex players. They sat it out, quite happy to enjoy a big surge in healthy customers fueled by billions in government subsidies. For that reason, it's very hard for me to see this mandate being repealed or the subsidies being cut back, even though they will stage a Grand Kabuki pretending that they will. It's just too good for business.

The Medicaid expansion, on the other hand, was always going to be the real political football.(Sometimes I thought it was meant to be.) This is where the battle will be joined in earnest, at least in the short run. Places like California will try to implement the new scheme and may succeed for a time. But if the deficit hawks have their way and put us on a harsher austerity path and/or the Republicans eventually succeed in changing the ACA Medicaid provisions to a block grant or something else, that part of the reforms will wither. And more immediately, we may see some obstinate zealots in the state houses and governors mansions who will take Justice Roberts up on his offer to reject the funding for the ACA.

And you know what that means. Here's Dday:

I was just on a conference call where Governor Martin O’Malley (D-MD) was asked whether he thought Republican governors might opt out of the Medicaid expansion in light of the Supreme Court’s ACA ruling yesterday. He replied, “I don’t know. Some of our colleagues would like to get out of being members of the Union.” I think that’s the right way to look at it. These are an ideologically extreme set of characters, and they’re not going to go quietly, meekly accepting funds that expands health care for poor people. That goes against their worldview.
[...]
It’s not logical or rational in the short term. But it’s pretty clear that will be their perspective. Especially because those who would be left on the other side of the divide, in the event of rejecting the Medicaid expansion, would so clearly be on the side of the “other”:

For people of color, the impact of the mess that the court just rolled down Pennsylvania Avenue and out into the country cannot be understated. Blacks, Latinos and Asians are up to three times less likely to have insurance than whites. Half of the nation’s uninsured are people of color.

The Center for American Progress estimates that this racial gap in health care coverage costs the country $415 billion a year in lost productivity.

For black and brown America, affordable, quality healthcare is key to closing a wider economic gulf [...]


Medicaid is a mitigating force in this lopsided system. Blacks and Latinos are enrolled in Medicaid at twice the rate of whites. Half of those in the program are children. As the Kaiser Family Foundation has bluntly concluded, “Medicaid enables Black and Hispanic Americans to access health care.”

The recession has made this more true than ever. Three out of four people who lose their job, also lose their insurance. As a result, the number of people in Medicaid has soared to 60 million.

60 million people.

During the Health Care negotiations when we were all obsessed with the public option, I recall speaking to a progressive congressman about whether or not they were willing to form a bloc and kill the bill since the PO had been tossed. He said to me that he would love to but he couldn't walk away from this expansion in Medicaid, it was just too important to the working poor. I supported the bill for the same reasons. I thought we could do a lot better than this crazy set-up for the private insurance market, but the Medicaid expansion was getting through without much controversy, which I thought was a miracle worth taking and running with.

But I never thought the centrists and conservatives wouldn't try to fuck with it every chance they got. For the reasons Dday outlines above, it will be the new "welfare" with all that that implies.

The Medicaid expansion was the liberal piece of the reforms, government funded health care for the working poor. In my view that's where progressives should focus their energies and get out ahead of the inevitable conservative onslaught.

Update: By the way, let's not forget who brought up the Medicaid "option" in the first place:

Sen. Ben Nelson (D-NE) has announced that Senate Democrats would have to allow states to “opt-in” to the Medicaid expansion to secure his vote for the Senate health care bill. In a letter to Nebraska Governor Dave Heineman, who has previously raised concerns about the provision in the Senate bill that would expand Medicaid to 133% of the federal poverty line (FPL), Nelson wrote “In your letter you note that the current Senate bill is not in Nebraska’s best interest. I agree. That is why I continue to work to change it,” Nelson wrote. “Under my proposal, if Nebraska prefers not to opt in to a reformed health care system, it would have that right.”


I'm just saying: don't count on the Democrats to automatically protect this from the vultures.

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