(AP/J. Scott Applewhite/Chris Usher/Timothy D. Easley)

“Awesome in its evilness”: How to make GOP pay for its Medicaid nightmare

Obamacare used to be Democrats’ debacle -- but now it’s time to go on offense. Here’s where Republicans are exposed

David Dayen
April 16, 2014 3:45PM (UTC)

Liberal backers of Obamacare have increased their fury in recent weeks over how 24 states, controlled in part or in whole by Republicans, have rejected the law’s Medicaid expansion, which the Supreme Court ruled they could do without consequences back in 2012. This has denied 5 million Americans health insurance coverage. “It really is just almost awesome in its evilness,” said Jonathan Gruber, one of the architects of healthcare reform. “It appears to be motivated by pure spite,” added Paul Krugman. “I am burying my best friend because of the policies of the Republican Party,” remarked one anguished woman in a viral story about Charlene Dill, a 32-year-old from Florida who would have been covered by Medicaid under the expansion, but instead went without the care she needed, and collapsed while working.

People are right to be outraged. These states are turning down full funding for the expansion for three years, and 90 percent thereafter, declining the economic stimulus from the flow of that Medicaid money. And this will lead to somewhere between 7,000 and 17,000 preventable deaths due to a lack of coverage, according to public health researchers. Charlene Dill’s story will unquestionably be repeated throughout the country.


But this outrage is a surprisingly new phenomenon, particularly among leading Democrats. Nancy Pelosi, the day of the Supreme Court ruling, said flat-out, “I don’t think governors will turn that down.” The White House was even more dismissive, as this Kaiser Health News story notes, also from the day of the ruling: “Senior White House officials were asked by a reporter how they would entice states to participate. They laughed.”

As Jim Newell wrote in Salon this week, that didn’t work out. And the complacency was clearly misguided from the start. The fact that these red states sued to overturn all of Obamacare should have been a tipoff that they wouldn’t exactly jump at the chance to expand coverage under the law, if they could opt out instead. Liberals mistakenly performed a cost-benefit analysis, thinking rationally, what state would turn down free money from the federal government to cover their poorest citizens? (In fact, that’s exactly what Jon Gruber admitted he thought initially.) But there’s nothing logical about knee-jerk opposition to anything proposed by the president, which has been the status quo in the Republican Party since Inauguration Day 2009. Indeed, Republicans predictably distorted the share that states would have to pay for the expansion, and highlighted the risk that Congress would at some point stick the states with a higher bill. That was enough of a sliver to give Republicans the talking points they needed to reject the expansion.

Instead of taking a political stand, and hammering Republicans with the issue in an attempt to rally voters to the cause and kick out those blocking expansion, Democrats appealed to history, smugly noting that every state eventually adopted the Medicaid program back in the 1960s. That this is a completely different ideological era didn’t occur to them. Worse, Democrats actually figured that hospital industry lobbyists would do their dirty work for them. This also made logical sense: Under the law, hospitals lose their disproportionate share payments from treating patients without insurance at the emergency room. Getting those uninsured into Medicaid would be crucial for the survival of hospitals, removing the cost burden of indigent care. But just days after the ruling, hospital industry leaders expressed concern that their mettle would not be enough to convince red-state governors. The lobbying push only worked in a couple of states at the margins.


In short, Democrats were always going to have a fight on their hands forcing the Medicaid expansion through, state-by-state, especially since conservatives have been told for half a decade that Obamacare is the devil’s handiwork. Assuming that rigorous study would allow the reasonable position to win out reveals a blindness to everything that has gone on in politics the last five years. And assuming that hospital industry lobbyists would make that fight in Democrats’ place reveals nothing short of cowardice. If you want to get something done in politics, you have to do it yourself. And that cannot merely be rooted in dollars and cents and wonkish arguments, but in a moral case about our responsibility to our fellow man.

I agree that the so-called bully pulpit only has so much force when going up against a conservative political establishment that remains dedicated to the downfall of Obamacare. But hoping this works out “eventually” is not a plan. Moreover, in the meantime, more Charlene Dills will die needlessly from lack of health coverage. There’s a real urgency here, and the purpose of political parties is to actually present solutions to the public and try to win the argument.

I can only think of one political campaign where the Medicaid expansion actually rose to the surface as an issue: last year’s governor’s race in Virginia. And Terry McAuliffe, running on a platform of expanding Medicaid, won (because the Legislature remained in Republican hands, that expansion has not yet gone through). The issue has real potential for Obamacare backers: New polling shows that even Republican voters support expanding Medicaid for their states.


Some progressive candidates do want to finally pull this out as a hammer for the fall campaign. “This is an incredibly important issue,” Shenna Bellows, candidate for U.S. Senate in Maine, told Salon. Maine is a flashpoint in this fight, because the Legislature actually voted to expand Medicaid, which would have covered about 70,000 poor residents, but Republican Gov. Paul LePage vetoed the bill. “This draws a clear contrast in my race and the governor’s race,” Bellows said. “I believe universal healthcare is a human right, and the governor’s veto will definitely be an election-year issue.” MoveOn.org’s public battle in Louisiana to hold Bobby Jindal accountable on the Medicaid expansion shows that progressive groups would have the back of any candidate who decided to make his or her stand on Medicaid expansion. This movement is ready to break out; Democratic leaders just need to throw in with it.

As Salon alum Brian Beutler puts it, the liberal commitment to logic and empiricism is a strength, but at the same time, liberals too often believe the facts will speak for themselves, instead of seizing political advantage. Maybe it’s messy to play politics with people’s lives, but I’m sure the people whose lives are at stake won’t mind. There must be consequences for this practice of cruelly leaving poor Americans without health coverage in a proxy fight against Obamacare. Democrats cannot will Medicaid expansion into existence in red states by sitting on the sidelines, tut-tutting that Republicans “would be crazy not to take such a good deal,” or hoping that things will simply work out. They have to actually fight. The delay in coming around to this reality was inexcusable; now there’s at least a chance to build the movement necessary to accomplish this.


Jerry Seib: Some Good News for Dems on Obamacare

David Dayen

David Dayen is a journalist who writes about economics and finance. He is the author of "Chain of Title: How Three Ordinary Americans Uncovered Wall Street’s Great Foreclosure Fraud," winner of the Studs and Ida Terkel Prize, and coauthor of the book "Fat Cat: The Steve Mnuchin Story." He is an investigative fellow with In These Times and contributes to the Intercept, the New Republic and the Los Angeles Times. His work has also appeared in the Nation, the American Prospect, Vice, the Huffington Post and more. He has been a guest on MSNBC, CNN, Bloomberg, Al Jazeera, CNBC, NPR and Pacifica Radio. He lives in Los Angeles.

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