Joshua Holland, author of The Fifteen Biggest Lies About The Economy and a senior producer for Bill Moyers, has been spectacularly scrupulous in exposing right-wing talking points about the economy. This week he explained how "all private insurance premiums in the 25 red states that are refusing to expand their Medicaid programs will be 15 percent higher as a direct result of that decision." His overall assertion is what many people already knew in their hearts, namely that the single biggest problem with the rollout of the Affordable Care Act is a deliberate agenda of sabotage and obstruction by the Republican Party. Disingenuous conservatives are "complaining about insurance policies being cancelled and the ACA’s error-plagued exchanges at the same time as they actively work to keep millions of poor Americans from gaining coverage under the law’s Medicaid expansion."
The victims of Obamacare’s implementation problems being hit the hardest, by far, are those whose incomes fall between the federal poverty line and the eligibility cutoffs in those 25 states rejecting Medicaid expansion. Not only will they be left uncovered, they won’t even be eligible for the generous subsidies that people earning slightly more than they do can use to buy insurance. It’s brutally unfair. The Kaiser Family Foundation estimates that 4.8 million poor adults may fall into that coverage gap-- about twice the number of people expected to pay more for their insurance when their substandard policies are cancelled.And it gets worse. In 40 states, adults without children are ineligible for Medicaid regardless of their income level. In 30 states, the parents of children who qualify for Medicaid may not be eligible themselves. All of these people would be covered under Medicaid’s expansion, but they’re being left high and dry in the 25 states who have rejected expansion. And while the problems plaguing healthcare.gov result from mismanagement and a contracting boondoggle, those red state lawmakers who refuse to expand Medicaid are inflicting this harm intentionally, based solely on their ideology.In other words, they’re actively working to maintain America’s shamefully high rate of uninsured. And that comes with deadly consequences. Because, in this country, we do ‘let ‘em die’-- we let the poor and the uninsured die from treatable illnesses every day.Last week, the Texas Observer ran a heartbreaking essay by Rachel Pearson, who recalled being a young medical student volunteering at a free clinic in Galveston, Texas. Pearson had a patient-- a poor, uninsured patient-- who was obviously very sick. But Pearson couldn’t properly diagnose his ailment with the resources available to the clinic. When his pain became severe, she sent him to an emergency room, but the personnel there refused to treat him because his symptoms weren’t an immediate threat to “life or limb.” As time passed, his condition deteriorated until he began having difficulty breathing. It was only then that an emergency room finally admitted him and diagnosed the cancer that had metastasized throughout his body. “It must have been spreading over the weeks that he’d been coming [into the clinic],” she wrote. He died a few months later. “The shame has stuck with me through my medical training-- not only from my first patient, but from many more,” wrote Pearson, who now heads the clinic.A 2009 study published in the American Journal of Public Health linked 45,000 deaths every year to the uninsured, even “after taking into account education, income, and many other factors, including smoking, drinking and obesity.” The lead researcher of the study, Andrew Wilper of the University of Washington School of Medicine, told the Harvard Gazette, “We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease-- but only if patients can get into our offices and afford their medications.”This is the real-world backdrop for our fierce debates over Obamacare. Yet Republicans’ answer to the uninsured crisis is to claim that having no coverage at all is better than being enrolled in Medicaid. And that’s why conservatives have no legitimate leg to stand on in griping about the program’s flaws, no matter how deep they run. Because when it comes to health care, the American conservative movement has nothing constructive to offer to fix the problem of getting more people health insurance-- they can only whistle past the graveyard.…Liberals like to point out that the Affordable Care Act was modeled on a conservative, market-friendly approach to reducing the number of uninsured-- a plan born at the Heritage Foundation and championed by such conservative luminaries as Newt Gingrich.But that’s only half true. It was a Republican plan 20 years ago, when conservatives still expressed an interest in governing responsibly. Today’s tea party-dominated movement sees health insurance as something that fosters dependency on the government, and must therefore be limited to those who can afford it themselves or get it from their employers.Liberals have every reason to be dismayed over the maddeningly problematic launch of the Affordable Care Act’s exchanges because their preferred route to expanding coverage-- building on the popular and already functional Medicare system-- would have avoided many of the problems plaguing this overly complex, public-private scheme. But conservatives, serving up only red-meat rhetoric about government takeovers and litigation run amok, have nothing real to offer in terms of solutions. As such, in a rational world they should have nothing to say about Obamacare’s rocky rollout.
As Jonathan Martin explained to NY Times readers yesterday, implementation of Obamacare is dividing Republican governors. At the Republican Giovernors Association meeting in Scottsdale this week there was what Martin calls a "sharp disagreement among those who have helped carry out the law and those who remain entrenched in their opposition." This is, for example, the difference between obstructionists like Scott Walker and Rick Perry and more mainstream conservatives like John Kasich and Chris Christie.
The governors who refused the Medicaid expansion money that is part of the health care law-- believing they had found a wedge issue-- are already boasting about it.“I said no,” Gov. Scott Walker of Wisconsin said, “because if I took the Medicaid expansion I’d be dependent on the same federal government that can’t get a basic website up and going even after two and a half years to come through with payments for Medicaid in the future when they start weaning off paying for 100 percent of coverage.”Under the new law, the federal government pays the entire cost of Medicaid expansion for three years and 90 percent after that.Mr. Walker, who is seen as a candidate who can potentially bridge the differences between the Tea Party and the Republican establishment, said conservatives would have long memories on how the law was carried out.“I don’t think it’s a deal-breaker, but I think it’s pretty high on the importance list for a lot of voters out there,” he said....Mr. Walker and Mr. Perry are not the only ambitious Republicans to sound a “Where were you on Obamacare?” line of attack. Senator Rand Paul said this week that Gov. Chris Christie of New Jersey, perhaps the leading 2016 contender among establishment Republicans, would have to answer for his decision to take the Medicaid money.“On the case of the New Jersey governor, I think embracing Obamacare, expanding Medicaid in his state is very expensive and not fiscally conservative,” Mr. Paul said.He added, “Many Republican governors I would say are conservative did resist expanding and accepting Obamacare in their states.”Mr. Paul’s criticism underlines one of the challenges governors face as they contemplate presidential campaigns. House members and senators do not face the same dilemma: While members of Congress vote on legislation, bills can be passed without their support. But governors face decisions that affect the residents of their states.Gov. John Kasich of Ohio expressed this political fact of life, becoming animated as he was questioned at a meeting with reporters here about his decision to expand Medicaid.“I always try to put myself in the shoes of somebody else to say: ‘How would I feel if I didn’t have health insurance? Are you kidding me?’” said Mr. Kasich, who has been mentioned as a 2016 hopeful, his voice rising. In defending Medicaid, he spoke at length about the scourge of drug addiction and challenges faced by those with mental illnesses.“It’s going to save lives,” he said. “It’s going to help people, and you tell me what’s more important than that.”The issue is a particularly delicate one among Republican governors, not only because they have disagreed on whether to take the Medicaid money, but because Mr. Christie, already a leading figure in the party, formally took over the Scottsdale meeting as the association’s chairman.…Mr. Kasich, asked if taking the funding could hamper his own presidential prospects, shot back, “Is that how you’re going to make a decision?”
At least they can all agree about one thing: Congress is a mess-- and the Republican governors don't seem to have any problem throwing John Boehner and his cronies under the bus.
• Rick Scott (R-FL)- "It's pure insanity, what's coming out of there"• Nikki Haley (R-SC)- "Chaos… we don't like the job they're doing"• Bobby Jindal (R-LA)- "Dysfunction"• Chris Christie (R-NJ)- "incredible contrast between what you see being discussed here… as opposed to what's going on in Washington, D.C."
And it's not just Republican governors bemoaning their own party's extremists in Congress. On a fat cat donor call sponsored by Rove, McConnell blamed Ted Cruz and Mike Lee for the ugly mess the Republicans find themselves in as they head into the 2014 midterms. McConnell said that the Tea Party movement is "nothing but a bunch of bullies" that he plans to "punch… in the nose."
On the call, according to a donor who was on it, McConnell personally named Sens. Mike Lee (R-UT) and Ted Cruz (R-TX) as Tea Party conservatives he views as problematic for him. “The bulk of it was an attack on the Tea Party in general, Cruz in particular,” the source, a prominent donor, said in a phone interview with Breitbart News.But the most memorable line came at the end of the call.“McConnell said the Tea Party was ‘nothing but a bunch of bullies,’” the source said. “And he said ‘you know how you deal with schoolyard bullies? You punch them in the nose and that’s what we’re going to do.’”Rove, as well as American Crossroads President and CEO Steven J. Law who also serves as the president of sister group Crossroads GPS, were also on the call. Rove “talked in a slightly gentler way, or let’s say, a more diplomatic way,” the source said. “But the message was pretty well the same: That if we’re going to save this thing, we have to back real Republicans.”
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