07.05.12

More on health care, post SCOTUS ruling

Posted in Around The Nation, Around The State, Health Care at 3:51 pm by wcnews

There’s been a tremendous debate since the Supreme Court (SCOTUS) ruling on the Affordable Care ACT (ACA) last week. No matter where one comes down on how the mandate was rationalized by the court, (is it a tax?), it really doesn’t matter. It does the same thing either way, It doesn’t matter if they call it a tax or a penalty.

It’s fairly obvious what the mandate does: once the government makes health insurance affordable (in theory), people who don’t pay for it will be penalized in order to prevent moral hazard, and to prevent people from not buying insurance until the minute they feel they might have a medical problem. Call it a tax, call it a penalty, call it whatever one wants: the concept is clear enough.

While the mandate was central to allowing the law to move forward, the issue that will matter most in people’s lives is how, or if in some states, the Medicaid expansion is implemented. The discussion about the Medicaid expansion fascinating and will be the main focus going forward. The reason it is so fascinating is because the issue has so many of the elements our country has been struggling with since the beginning. Race, taxes, fairness, equality and/or inequality, wealth, and the poor just to name a few. All around the subject of health care.

Because the expansion of Medicaid seems like a no-brainer and a good deal for states, Health Care Reform Defiance By Republican Governors Worries Hospital Industry.

To get a sense of what an incredibly, astonishingly, unbelievably good deal that is, consider this: The federal government currently pays 57 percent of Medicaid’s costs. States pay the rest. And every state thinks that a sufficiently good deal to participate.

But, somewhat perversely, the states that get the best deal under the law are states like Texas, which have stingy Medicaid programs right now, and where the federal government is thus going to pick up the bill for insuring millions and millions of people. In states like Massachusetts, where the Medicaid program is already generous and the state is shouldering much of the cost, there’s no difference for the federal government to pay.

That is to say, the less you’ve been doing on Medicaid so far, the more the federal government will pay on your behalf going forward. And that gets to an irony of the health-care law: Red states have, in general, done less than blue states to cover their residents, so they’re going to get a sweeter deal under the terms of the Affordable Care Act.

And the Healthcare ruling is good for Texas.

The U.S. Supreme Court’s decision to uphold the Affordable Care Act marks a giant step forward for millions of Texas children and families who can now get the healthcare coverage they need.

Because of our state’s highest-in-the-nation rates of uninsured, Texas stands to benefit from this decision more than any other state.

The nation’s health law has already improved the lives of millions of Texans. More than 7.5 million Texans, including more than 3 million children, have directly benefited from the law since 2010.

But the reality is that none of those arguments, logical and fiscally sound as they are, will likely be enough for the “Let him die!” party to just allow this to go forward. Here’s what the supposed moderate Speaker of the Texas House had to say.

“The battle to overturn the burdens this law places on American citizens by our elected leaders in Washington is not done. I will continue to urge the Texas Congressional delegation to dismantle this legislation and find real solutions to improve our health care system so Texans can have access to quality, affordable care. The Texas House will do its part during the next session by attempting to limit any negative impact the law might have on our state.”

It looks like there’s little that unifies the Texas GOP more then taking away people’s health care. One option to try and sway moderates, if there still are any in the GOP, is the moral argument.

Make the moral argument: Appeals to the Medicaid expansion being a “great deal” for states will fall flat. Conservatives won’t trust the source, and will shift the numbers in their favor. Plus there really are costs to expansion on the states, even if they’re minimal.

What cannot be elided is the idea that we have a responsibility to each other, and don’t want to see the day when our brothers and sisters die in the street for lack of medical care. I don’t expect this to reach the outer edges of the tea party right, but it should be able to sway moderates. Since 2008, the moral argument is the argument that has not really been employed. It was dropped in favor of arguments about “bending the cost curve.” But the idea that health care is an essential right and not a privilege has the ability to move people from where they are.

Conservatives and Republicans do not concede the moral imperative of universal health care — although that leaves them isolated in the entire advanced democratic world. There is no other country among our allies in Western Europe, Canada, Japan, and Australia that does not stipulate every citizen will have health insurance from birth as a matter of course. In all those countries, the center-right parties have long accepted the moral imperative, whatever initial misgivings they may once have voiced. So do the medical- industrial complexes of every nation but ours […]

So the moral issue must be joined in the most aggressive fashion possible. Not so much by showing empathy for the uninsured—liberals are always wonderful at showing empathy. No, by belligerently challenging conservative pundits and Republican politicians at every opportunity, reminding them how lucky they are to have health care themselves.

This is especially true in the case of Medicaid, which hits a vulnerable and often invisible population. Over the years-long battle for expansion, it is incumbent to make them visible and real and unforgettable. That’s a far better campaign to “I can’t believe what a good deal these people are passing up!”

But we can’t forget the historical context of all this, How Democrats fall into the welfare trap.

Digby and Dave Dayen have been doing a tremendous job of highlighting the ridiculous conventional wisdom that all of the GOP governors will opt in to the Medicaid expansion in ACA simply because the hospitals want them to. The CW assumes that Republican governors are driven purely by corporate greed, rather than a deep ideological commitment to the idea that the undeserving poor should be left to suffer out of a sense of Calvinist cosmic justice. For GOP governors and their base, there are two kinds of people: those who deserve to prosper and be happy and those who don’t. For them, the greatest injustice in the world is the taking of their tax dollars to assist the undeserving, and the removal of their private authority to abuse and exploit the undeserving.

[…]
I’ve said it before: what made the New Deal so popular and effective was the fact that most of its programs benefited everyone (well, at least everyone white.) The Civil Rights Era alienated a huge number of Americans who weren’t yet prepared to see women and minorities as equally deserving human beings. For liberalism to be politically palatable for enough of the public, the benefits of liberalism cannot be seen as going overwhelmingly to people that suburban and rural whites consider to be less than fully deserving of the same empathy and basic rights that they themselves enjoy.

As the Affordable Care Act becomes increasingly associated with Medicaid, and as Republicans continue to demonize it as taking away Medicare money to give to “undeserving” people, the Affordable Care Act itself will be unpopular.

Democrats need not be shocked by Republican governors’ refusal to accept Medicaid funds, and they need not feel that the experience of the Affordable Care Act means that Americans don’t like “socialized medicine.” What Democrats need to learn from this experience is that Democrats need to avoid the welfare trap, and need to embrace the power of universal social insurance.

Universal social insurance has always been popular and will remain popular when implemented. It’s just a matter of having the courage to enact it in the first place.

There’s a long way to go in the continuing fight for a better health insurance system in our state and nation. But the fight may not happen if Barack Obama isn’t reelected. This is also a huge opportunity for Democrats, especially in Texas, to show and huge difference between them and the GOP on health care. All Democrats should campaign on saving health care for millions of Texans and guarantee to work to expand health care for millions more. Because it’s the right and moral thing to do, and because it’s obvious the GOP won’t.

Further Reading:
The Affordable Care Act’s big giveaway to stingy red states.
Federal agency ranks Texas at bottom for health care.

In nine out of 12 categories Texas rated weak or very weak. The only area where Texas ranked good was in maternal and child health care measures. A spokeswoman for the Texas Health and Human Services Commission did not immediately reply to a request for comment.

Texas offers one of the most limited health care programs in the nation for the disabled and the poor, and more than 25 percent of Texans do not have health insurance of any kind, the highest in the nation.

Read the report here, and the specifics on Texas.

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