The Affordable Care Act's fix for Medicaid

A provision within the Affordable Care Act (ACA), or “Obamacare” as it is commonly called, was supposed to fix that. It was supposed to save the lives of the nation’s poor people facing medical crises. Can it provide universal coverage for the nation’s poor? That seems unlikely to me under the present circumstances.

To aid the victims of Medicaid’s inadequate coverage, the ACA included a provision to expand the Medicaid program, coupled with generous federal assistance to the states. States that refused this Medicaid extension would lose ALL of their federal Medicaid money.

It was a carrot and stick approach applied to the states. That was supposed to fix Medicaid’s problems. However the Supreme Court struck down the “stick” saying that the federal government could not threaten complete denial of its Medicaid funding.

Poor people certainly needed better health care from the states.

The attacks on Medicaid coverage

Mary Flowers, a state representative from Chicago, IL decried the June 2012 Medicaid cuts in her state by saying this:

“I’m begging you...for the life of the people who are going to die as a result of this legislation. I’m begging you. Please, let us do something different.”

She was ignored. Illinois Governor Pat Quinn signed a budget that would drop over 26,000 people from the FamilyCare, a Medicaid program. The Illinois Cares Rx program (which is separate from Medicaid) is now completely dead, meaning costs for prescription drugs would go up for many senior citizens and people with disabilities.

Pennsylvania Governor Tom Corbett had previously cut nearly 90,000 children off the Medicaid rolls between August 2011 and January 2012, claiming that their paperwork was not in order. Some children have had their coverage restored and Corbett’s recent attempt to cut Medicaid funds to nursing homes was blocked by the Pennsylvania state legislature.

For Kheli Muhammad, Corbett’s “children’s purge” provoked deep worry about the life of her 2 year old son Samad who must wear a pacemaker to keep his heart going. When she took him for a routine doctor’s visit she discovered he had been cut from the Medicaid rolls. It took her a heart-wrenching week to get him back on:

"I didn't even get a notice that he would be canceled. Nothing had been sent to my house. Because of my son's condition, it's not something that would have slipped by."

Slashing Medicaid at the state level has come from both parties, although the Republicans have been far more enthusiastic about it. Illinois Governor Pat Quinn is a Democrat. Pennsylvania Governor Tom Corbett is a Republican. Ironically, the 5-4 majority on the Court that took away the federal stick was also a bipartisan affair with the Court’s four Democrats voting with Republican Justice John Roberts.

The resistance to Medicaid expansion

According to Think Progress, 10 Republican Governors have already said they will refuse the Medicaid extension, while 19 have not committed themselves. It is rumored that perhaps 3 Democratic governors may refuse. Sixteen states, all with Democratic governors, have signed on to the extension. Think Progress estimates that as many as 3.5 million people may be denied coverage so far, up to 10 million more if other governors refuse the Medicaid extension.

So where does this leave the poor, people like Denise in Florida, where Governor Rick Scott has already rejected the Medicaid extension:

“I work full time – hours at the office and at home – around my three children and their needs. Since the cost of medical insurance has gone so high it costs hundreds for coverage I can’t afford if we are to eat and have a roof over our heads.”

Peter Orszag, a former White House staffer who helped craft the ACA, is optimistic, saying that the generous federal subsidy would be hard for states to resist, although he did say,”There may be significant gaps that open up, and that would be unfortunate.”

I’m afraid I don’t share Mr. Orszag’s somewhat rosy assessment of state cooperation and I wouldn’t call 10 million possibly uninsured people “unfortunate”, I’d call it a health care Katrina.

Race matters in the Medicaid battle

One of core values of today’s Republican Party is an ugly white supremacy that racializes poverty in this country. For politicians like Rick Scott, Sam Brownback, Bobby Jindal, and Nicky Haley this is their bread and butter. Their core voters don’t want tax dollars going to poor people of color whom they despise and blame for the nation’s economic problems.

Some analysts maintain that the medical-industrial complex, which would profit off of Medicaid expansion will successfully pressure these state politicians into submission. The magic of the marketplace supposedly will triumph again. But that assumes rationality in a nation where racism has maintained a tenacious hold since its very founding. Is race the only reason for resistance to Medicaid expansion? No, but I believe it is a key factor.

The resistance to federally mandated health care for the poor is starting to look like the massive resistance to desegregation that broke out after the 1954 Brown v. Board of Education decision. That low income whites were also hurt by Jim Crow segregation did not threaten the political careers of the racist Dixiecrat politicians of that time. Low income whites will be hurt by resistance to Medicaid expansion today, but Republican politicians do not seem to fear any political repercussions from that.

If the Democratic Party wants to mandate Medicaid expansion on unwilling state governments, they are going to need another federal stick. I doubt the national Democratic leadership will be looking very hard. The Obama administration has made the “middle class” its political centerpiece. The poor are hardly mentioned and race is avoided as if it were an especially virulent strain of the Ebola virus. Democratic Party politicians who do strongly advocate for poor people are a minority among its political leaders.

The Affordable Care Act will most likely benefit working class people who are better off, while leaving poor people at the mercy of state governments. Will it be possible to unite those two groups to fight for universal coverage? How would this happen given the racial and geographic divisions within the working class and the weakness of the labor movement? The “death panels” made famous by Sarah Palin are already assembling in state houses around the country, deciding who will get health care and who will not, making life and death decisions that will affect millions.

Personally I favor a Medicare for All solution that puts private insurance companies out of business. I don’t think regulation is the answer. We have the EPA but we still have massive pollution. We have the SEC but we still have billions of dollars in Wall Street fraud. We have OSHA but workers are still maimed and killed at alarming rates.

Around the world nations have achieved universal coverage in a variety of ways and with varying degrees of success. But thanks to American exceptionalism and our myopia about whom we share our planet with, most Americans are unaware of alternatives. Most of us couldn’t even describe the health care systems of our nearest neighbors, Canada and Mexico.

Here in the USA, universal coverage, by whatever means, is still a goal, not a reality. Progressives and socialists both outside and inside of the Democratic Party will need to unite to make it happen. Being a political minority did not stop the civil rights movement from challenging the massive resistance to desegregation. Being divided within itself over tactics and strategy did not stop the civil rights movement either.

Can progressives and socialists summon the will to lead a movement to make quality health care another one of our basic civil rights?

The clock is ticking.

Sources Consulted

Health Care Benefits On The Line As States Struggle With Medicaid Costs by Jeffrey Young

Optional Medicaid benefits face state cuts by Phil Galewitz

Fifteen governors reject or leaning against expanded Medicaid program by Elise Viebeck

GOP Governors May Turn Down $258 Billion In Obamacare Funds, Leave 9.2 Million Americans Uninsured

In name of states’ rights, millions could go uninsuredby Greg Sargent

Moms Speak Up for Medicaid

Thousands of Illinoisans to be affected by Medicaid cutsby Dean Olsen

Uncovering kids: 89,000 poor Pa. kids slashed from Medicaid by Michael Hinkelman & Catherine Lucey

New state budget is clear cut on winners and losers by Robert Swift

Medicaid cuts: feeling the "ill effects" by Anna Yee

Most states proposing FY 2012 Medicaid cuts