The scourge of the ‘wingnut hole’

We have a reasonably good sense of how many Americans have enrolled in the health care system in recent months, signing up for coverage made available through the Affordable Care Act. For a more ambitious tally, Josh Marshall includes exchanges, Medicaid, young adults staying on their family plans, and those who were able to bypass exchanges to buy ACA-compliant policies directly from insurance carriers, for a grand total of about 10 million.
 
But every time these numbers are culled, it’s worth remembering that the coverage totals would be far greater were it not for “red” states refusing to accept Medicaid expansion.
 
The original plan, you’ll recall, was to simply mandate the greater access. The U.S. Supreme Court, however, said states must have a choice as to whether or not to accept the good deal. Most Republican-led states, naturally, rejected the policy, leaving millions behind for no particular reason.
 
But how many million? The Associated Press published a report this week with a striking figure.
About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America.
 
They make up a coverage gap in President Barack Obama’s signature health care law created by the domino effects of last year’s Supreme Court ruling and states’ subsequent policy decisions.
This coverage gap clearly needs a name. Ed Kilgore started calling it the “wingnut hole” months ago, and it’s certainly a descriptive phrase. Ryan Cooper added the other day:
It’s worth remembering that the federal government will pay 100 percent of the cost of the Medicaid expansion through 2016 and 90 percent of the cost afterward. It could very well work out that refusenik states will not even save money because of additional spending on the uninsured in emergency rooms and elsewhere.
 
But regardless of the pitiful sums involved, make no mistake: This action is utterly gratuitous.
Quite right. In fact, as we’ve discussed many times, Republicans at the state level who refuse Medicaid expansion generally struggle to explain their position in any kind of coherent way.
 
What’s more, let’s not forget the irony of the larger context: congressional Republicans spent most of their waking hours complaining about a sliver of the population receiving “cancellation notices” through the Affordable Care Act because of changes to the individual market. Indeed, GOP officials routinely claim this will leave 5 million Americans behind with nothing (a total that appears to have been exaggerated by a factor of 500).
 
And yet, if their concern were genuine, wouldn’t Republicans necessarily be outraged by these 5 million Americans who are suffering because some red-state policymakers are acting out of petty partisan spite?
 
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The scourge of the 'wingnut hole'