Posted by: Donna
The Supreme Court decision on the Affordable Care Act, AKA “Obamacare”, upheld the mandate, which was considered the linchpin of requiring insurance companies to expand coverage to millions of Americans and creating exchanges to accomplish that. But the other, less noticed but equally significant, part of the decision allows states to opt out of the Medicaid expansion. That provision of Obamacare extends health coverage to an estimated 16 million low income Americans, who can’t afford private health insurance even with substantial subsidies. However, it relies on states to share the cost of providing Medicaid to residents up to 133% Federal Poverty Level (FPL). Matt Ygleslias of Slate explains why this is more complicated than it looks:
So somewhere in the legislative sausage-making, budget-conscious centrists realized that it would be cheaper to rely heavily on Medicaid expansion to achieve the Affordable Care Act’s coverage goals. To an extent this is exactly what liberals have been saying about single-payer all along. But in this case it played as a centrist desire to keep the bill relatively cheap. The problem is that most of the Medicaid expansion that would have to happen would have to come from politically conservative states. So Congress’ approach was essentially to make Red America an offer it couldn’t refuse—expansion could be done on very generous terms with the federal government picking up over 90 percent of the tab, but failure to expand would come with a hefty financial penalty in terms of lost matching Medicaid grants.
Chief Justice Roberts joined with the other conservatives on the court to argue that this penalty—withdrawing of existing federal money unless states kicked in new money of their own—overstepped the constitutional bounds of the spending power. So now states have the carrot to expand Medicaid but not the stick.
Since your state’s citizens have to pay taxes to the federal government one way or the other, you’d have to be pretty crazy to refuse the carrot, if you ask me. But ideological zeal may well lead some states to turn it down. In that case, substantially more people than the law’s authors expected might find themselves eligible for either hardship waivers from the mandate or subsidies to buy insurance on exchanges. How much of each of those things happened will depend on exactly what states do, and figuring out the budgetary implications of the whole thing is going to require some hard work by the little modeling gnomes at the Congressional Budget Office.
Nothing describes the overall demeanor of Arizona Republican politicians better than “ideological zeal” so I don’t expect the GOP majority here to jump on widening Medicaid to include more Arizonans under Obamacare, even with generous federal help to do so. After all, they were quick to use the economic downturn as an excuse to cut thousands of Arizonans off the Arizona Medicaid rolls last year.
Back in 2000, Arizona voters approved Prop 204, an initiative to cover all residents below 100% FPL. Conservatives here hated it from the beginning. When Republicans swept Arizona statewide offices and the legislature in 2010, they were quick to cut Prop 204 funding (cutting all childless adults off Medicaid) and place an enrollment cap on Arizona’s KidsCare program, which provides health care assistance to low income children. That KidsCare cut “saved” the state $13 million while causing Arizona to lose $41 million in federal funds. So it’s fairly obvious that Arizona’s “pro-life” Republican politicians are more than willing to sacrifice human lives on the altar of Grover Norquist. Recall how, in 2011, Republicans in the Legislature refused federal unemployment extensions that would have cost the state nothing on the purely ideological grounds that such aid would help worthless slackers.
Arizona is not the only Red state whose poorest citizens are in a bind because Justice John Roberts triangulated on the Obamacare decision. 25 other states joined Arizona in suing the federal government to avoid having to implement the Medicaid expansion. The willingness to go along with the Medicaid expansion seems to go along stark red/blue lines, with Blue states eager to leverage the Obamacare funding and Red states saying, basically, “No thanks, our poor people can just go ahead and die.” No amount of reasoning or cajoling will make them budge from that.
So what does this mean? It means one thing: Elect Democrats in Arizona in 2012, in every election possible. No use handwringing and pining for magical moderate Republicans (looking at you, Laurie Roberts) to save us. Lives literally depend on getting Democrats in office this year.
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