The cost to the states is tiny, and the help it would bring to the poor is immense. It's paid for by taxes that residents of these states are going to pay regardless of whether they receive any of the benefits. And yet, merely because it has Obama's name attached to it, they've decided that immiserating millions of poor people is worth it. It is hard to imagine a decision more depraved. Alternatively, Republicans in Congress could agree to fix this problem and allow people without access to Medicaid to qualify for exchange subsidies. But of course they won't do that either for the same reason. Conservatives hate it when you accuse them of simply not caring about the poor. Sometimes they have point. This is not one of those times.
Even if the Affordable Care Act is implemented perfectly, and the system works exactly as planned, millions of Americans will go without access to affordable health care. Is it due to a flaw in the law? Not exactly.
The problem is Republican opposition to Medicaid expansion at the state level. If your income is between 100% and 138% of the poverty line, you can qualify for Medicaid and get covered -- unless you live in a "red" state where GOP officials have rejected Medicaid expansion. If so, you can (a) move; (b) figure out a way to make more money; or (c) go without.
Just in recent days, we've seen reports reinforcing how inexplicable these states' policies really are. Refusing Medicaid expansion will not only cost states billions, but it will also severely undermine state hospitals, all while hurting struggling families.
Kevin Drum today called it "one of the most sordid acts in recent American history."
I strongly agree, though I'd just add that it's amazing to hear Republican governors who reject Medicaid expansion try to present their approach as sensible.
Wyoming Gov. Matt Mead (R) recently said he refused the policy because he doesn't like exchange marketplaces, which doesn't make any sense. Alaska Gov. Sean Parnell (R) justified his opposition by saying the health care law is a "mess," which is shallow even by GOP standards. Wisconsin Gov. Scott Walker (R) appeared on MSNBC and said he rejected Medicaid expansion because, someday, federal officials may "renege on their promise" to reimburse states.
Has that ever happened? No. Is there any reason to believe it might happen? No. Could Wisconsin bring coverage to struggling families in the meantime, and then drop the policy in the event Washington refused to meet its obligations? Yes, but Walker doesn't want to.
The larger takeaway here is that Republican officials increasingly appear eager to punish the poor because they're poor. Indeed, it's become a common theme in GOP policymaking just in recent weeks: no extension of unemployment benefits, no extension of the status quo on food stamps, no increase in the minimum wage, and wherever possible, no Medicaid expansion, either.
Republicans better hope low-income Americans vote in low numbers in the near future.