Paul Krugman: GOP won’t expand Medicaid out of “pure spite” and “startling ugliness”

The New York Times columnist says the GOP has no answer to Obamacare's success — except denial and opposition

Topics: Paul Krugman, Jonathan Gruber, Obamacare, Affordable Care Act, Medicaid, The New York Times, Mitch McConnell, , ,

Paul Krugman: GOP won’t expand Medicaid out of “pure spite” and "startling ugliness"Paul Krugman (Credit: Reuters/Anton Golubev)

In his latest column for the New York Times, award-winning economist and best-selling author Paul Krugman argues that the early success of Obamacare has left Republicans with no answers — other than spitefully punishing the poor by refusing to expand Medicaid in their states.

Mocking Senate Minority Leader Mitch McConnell for recently calling Obamacare “a nightmare,” Krugman writes, “[W]hile Obamacare is looking like anything but a nightmare, there are indeed some nightmarish things happening on the health care front.”

“For it turns out that there’s a startling ugliness of spirit abroad in modern America,” he continues, “and health reform has brought that ugliness out into the open.”

Before explaining what he means by ugliness, however, Krugman reminds readers of Obamacare’s recent success. He cites the late-March surge in enrollments, the dropping percentage of uninsured Americans, and early indications that the number of people who lost health insurance due to Obamacare’s new standards is far smaller than originally believed.

“Republicans clearly have no idea how to respond to these developments,” Krugman writes. “They can’t offer any real alternative to Obamacare, because you can’t achieve the good stuff in the Affordable Care Act, like coverage for people with pre-existing medical conditions, without also including the stuff they hate, the requirement that everyone buy insurance and the subsidies that make that requirement possible.”

So rather than offer legitimate alternatives to Obamacare, Republicans have, according to Krugman, chosen instead to “talk vaguely about replacing reform while waiting for its inevitable collapse. And what if reform doesn’t collapse? They have no idea what to do.” The best they can come up with, Krugman writes, is simply blocking Obamacare’s Medicaid expansion wherever they can — and hurting their own fellow citizens, millions of whom need but cannot afford health insurance, in the process.

He continues:



What’s amazing about this wave of rejection is that it appears to be motivated by pure spite. The federal government is prepared to pay for Medicaid expansion, so it would cost the states nothing, and would, in fact, provide an inflow of dollars. The health economist Jonathan Gruber, one of the principal architects of health reform — and normally a very mild-mannered guy — recently summed it up: The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Indeed.

And while supposed Obamacare horror stories keep on turning out to be false, it’s already quite easy to find examples of people who died because their states refused to expand Medicaid. According to one recent study, the death toll from Medicaid rejection is likely to run between 7,000 and 17,000 Americans each year.

But nobody expects to see a lot of prominent Republicans declaring that rejecting Medicaid expansion is wrong, that caring for Americans in need is more important than scoring political points against the Obama administration. As I said, there’s an extraordinary ugliness of spirit abroad in today’s America, which health reform has brought out into the open.

And that revelation, not reform itself — which is going pretty well — is the real Obamacare nightmare.

Elias Isquith

Elias Isquith is an assistant editor at Salon, focusing on politics. Follow him on Twitter at @eliasisquith, and email him at eisquith@salon.com.

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