Let Them Eat States’ Rights

I have more on the abominable GOP alternative to the Affordable Care Act:

The Medicaid expansion of the ACA is perhaps the most important achievement of the ACA, greatly expanding health coverage to the working poor. The Republican plan would undo most of this progress, eliminating both the requirement raising Mediciad eligibility to 138 percent of the federal poverty line and the requirement that all individuals within this window (rather than a relatively small subset) be eligible. It would also eliminate the increases in Medicaid payments to physicians that will make medical care more accessible to Medicaid recipients. What the Republicans offer instead is the familiar conservative refrain justifying opposition to social progress: let them eat states’s rights. Rather than the expanded eligibility of the ACA, Burr-Coburn-Hatch would just give states a fixed amount of money per head reflecting the eligibility standards of a given state (which in the majority of cases would be much less expansive than the ACA’s standard.)

In the current political context, the idea that giving more autonomy to the states is a magic formula that will lead to more efficient health care coverage for the working poor is particularly absurd.  The Supreme Court’s unfortunate decision to invent new doctrine and strike down the funding mechanism that would have made a 50-state Medicaid expansion likely provides a natural experiment revealing how serious Republican governors in red states are about covering the working poor. The results are in: most conservatives at the state level would rather leave huge amounts of money on the table than increase health care access for the working poor. The assumption that giving the states less money with many fewer strings attached would in itself result in superior coverage for the working poor is a cruel farce.

And yet, using this awful proposal as the baseline for Republican health care policy is probably too charitable. History suggests that absent the need to pretend to have an alternative to the status quo the Republican proposal for reform is non-existent. But even if one assumes that this proposal is in good faith, it shows Republicans treating those without access to decent medical care the same way they’re increasingly treating the unemployed and those who can’t afford to put food on the table: with callous indifference.