Paul Ryan, as you may have heard, has yet another “let them eat states’ rights” anti-poverty plan out. I note that this very old and very terrible idea is a source of grim amusement, given the latest conservative legal theory being used against the ACA:
The notion that “let them eat states’ rights” is a new and exciting idea is particularly perverse given some other recent developments. To the widespread applause of Republicans, a panel on the D.C. Circuit Court of Appeals read the Affordable Care Act as not providing subsidies to people purchasing health insurance on federally established exchanges. According to defenders of the decision, this was not a drafting mistake; they say Congress intended to only make the subsidies available on state-established exchanges, but were surprised by how few states went along.
As a reading of the ACA, this argument is absurd — clearly Congress anticipated that some states would not establish exchanges, which is why the federal backstop was created. Virtually nobody involved in creating the ACA believes that the law was designed to create federal exchanges that wouldn’t work. It is fair to say, however, that some Democrats were surprised by how many states proved unwilling or unable to establish their own exchanges.
But consider the implications of this. The latest conservative legal argument against the ACA boils down to: “you screwed up — you thought the states actually wanted to provide people with health care!” And the Supreme Court re-writing the ACA in 2012 to make it easier for states to reject the Medicaid expansion has also been a catastrophe, with Republican statehouses inflicting easily avoidable pain and suffering on millions of people to prove their anti-Obama bona fides.
So — why is devolving anti-poverty policy to the states supposed to be a great idea again?
The ACA has given us a very powerful lesson: “coercive federalism” is far more effective than “cooperative federalism.” The vastly improved Medicaid would have been much more vastly improved had it just been a federal program like Medicare. Hopefully we’ve learned something.
I give the concluding line to Charlie Pierce: “[B]lock grants to the states suck. They always have and they always will, and Paul Ryan knows this, which is why he gave them a pretty new name in the first place.”