Tuesday, July 10, 2012

Irresponsible, Not Insane

You might think they're crazy or at least hopelessly foolish.  But they're not.

Under terms of the Affordable Care Act, the federal government pays  state governments 100% of the cost through 2017 of expanding Medicaid, with the percentage dropping to 90% in 2020.

Chief Justice Roberts deserves much of the blame for the resistance remaining to Medicaid expansion of many of the 26 states which filed suit against the PPACA.     He ruled that Congress could not deny full Medicaid funding to states choosing not to expand coverage, but only funding for the additional individuals added to the program under the Act.

No doubt some Repub legislators and chief executives fear that, with a growing national debt, the federal government would not follow through with its promise of future funding.    But they know that Democrats would continue the funding.   It is only the members of Congress belonging to their own GOP who would plausibly put at risk the nearly 100% subsidy for the needy citizens of their states.    An analogous situation exists with the effort to expand job opportunities for Americans in need of employment is demonstrative.   Think Progress found

This trend of public job depletion puts the Republican jobs agenda in stark contrast with the administration’s approach. President Obama’s American Jobs Act would not only add 1.9 million jobs next year, but makes targeted investments to arrest the trend in layoffs. The plan includes $35 billion in direct state aid infusion that will “prevent up to 280,000 layoffs of teachers, who are — along with cops and firefighters — particularly vulnerable to local government budget shortfalls.”

However, Republicans continue to block Obama’s much-needed plan because, in part, they see public job loss as a positive.

With such a sweet deal being offered the states, it is becoming increasingly clear that a large chunk of the GOP sees health care loss (for poor individuals) as a positive.   A Forbes contributor reasons
Are these red state governors really going to sit by and watch the taxes their citizens pay to the federal government flow to the benefit of their neighboring states as the recalcitrant governors allow their own residents to miss the benefit of that money?

I don’t think so. Ideological opposition is one thing—denying access to health care to voters who could certainly use it when, to do so, would cost the state a relatively tiny amount of money, is just dumb politics.

Ron Pollack, director of Families USA, notes "it would be an act of fiscal malpractice for states to turn this down."   And Ezra Klein, acknowledging the resistance of several legislatures and chief executives nonetheless argues

that won't last forever.  and governors also have to answer to non-Republican voters who don't want their state missing out on billions in federal dollars, and to the hospitals in their state who have to treat uninsured patients that end up in their emergency room,s, and the insured voters who end up paying for their uninsured brethren.

Plus,when they want to flip-flop on the issue,they'll have an easy argument with which to do it:  It's a way to stick it to those blue states that put Obama back in Office.

Hospitals generally support the expansion.   The president and chief executive officer of the Texas Hospital Association explains "without the Medicaid expansion, many will remain uninsured, seeking care in emergency rooms, shifting costs to the privately insured, and increasing uncompensated care to health care providers.     With a strained state budget, it's hard to imagine addressing the uninsured problem in Texas without leveraging federal funds, which will now go to other states that choose to expand their Medicaid program."

Still, the Republican governor of South Carolina, Nikki Haley, now has joined the GOP governors of Louisiana, Florida,, Iowa, Mississippi, and Texas in announcing opposition to acceptance of federal dollars to boost provision of health care services to poor residents.  There will be more.   Digby comments

Here you have the Federal government paying for 100% for the first years and then 90% thereafter and they still won't ake yes for an answer.  So I think we can feel fairly confident at this point that it isn't really about the funding at ll, can't we?  It's about their belief that "those" people who don't "deserve" medical care shouldn't get it.

On the same site, and linking to Digby's commentary, David Atkins adds

It's not just about giving rich people more money.  The modern Republican establishment is most obsessed with enforcing a cosmic law of reward and punishment wherein poor people suffer and die early because they din't pull themselves up by their bootstraps enough to be rich.  It's a matter of principle, and they're more than willing to anger their allies in the hospital, health insurance and pharmaceutical industries to make ti happen.

The Ayn Rand nonsense isn't just rhetorical cover to enrich their already wealthy friends.   These People really believe in it.   They cannot be bargained with and cannot be reasoned with.  Its clear that pity and remorse are off the table, and they don't even fear the retaliation of the electorate.

Republicans (and much of inside Washington) were appalled- appalled!- when California congressman Alan Grayson, during the health care reform debate, had the temerity to declare on the House floor "if you get sick, America, the Republican health care plan is this:  Die quickly."

Health care reform passed, the prescient Grayson was defeated for re-election, the Supreme Court (somewhat) upheld the legislation, and GOP-dominated states are balking  at implementation.    There are factors at work beyond what Heather Digby Parton, David Atkins, and Alan Grayson point out.   When patients continue to flock to emergency rooms whose hospitals must, under terms of the Emergency Medical Treatment and Active Labor Act (EMTALA), continue to treat them without reimbursement, many administrators wil blame "the government."   Many of the patients, lacking Medicaid and receiving inadequate care in emergency rooms, will blame "the government."     And when South Carolina and Texas, among the national leaders in health care, are further stigmatized, residents and voters will blame "the government."

But while GOP politicians are all too pleased to see government continue to be a scapegoat, they are not reluctant to accept credit when they can.     Tuesday, Texas governor Rick Perry sent to HHS Secretary Sebelius a letter in which he declared opposition to both the state health care exchanges and medicaid expansion, arguing "the PPACA would simply enlarge a broken system that is already financially unstable."     The Medicaid provision, he wailed, "would threaten even Texas with financial ruin." Perry concluded  "I look forward to implementation of health care solutions that are right for the people of Texas.  I urge you to support me in that effort."    

That approach is not as cryptic as it appears.   Appearing on Fox News only hours after he sent the letter, the governor
stated "If the federal government were serious about working with the states … what they would do is block grant those dollars back to the states."    Rick Perry to American taxpayers:  "Send money.   A lot of it.   I'll decide where it goes and take the credit.   You stink."

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