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State governments across the USA have been cutting Medicaid and health care-related funding faster than Smithfield butchers hogs. These programs were supposed to help low income people, many of whom already suffer from the poor health that often comes with poverty. 

When care is restricted or cut off altogether, some people are going to die prematurely. They will most likely die quietly, perhaps mourned by their families and friends. Some will die alone.They may die in great pain or they may pass away in their sleep, but inevitably, some deaths will result from decisions made by politicians who don’t worry about choosing between food and medicine. One of the persistent myths in the USA is that poor people can "always get free health care" if they want it. We need to dispel that myth. Somehow.

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

Originally posted to BobboSphere on Wed Jul 04, 2012 at 10:48 AM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Maybe migration will happen, (14+ / 0-)

    but Howard Dean says the powerful medical lobbies and hospitals will strangle the governors before they refuse.

    We shall see.

    •  I hope to be proved wrong about the refusal. (7+ / 0-)

      The medical-industrial complex will probably approach the Republican governors with some offers that will be hard to refuse.

      Perhaps the governors will merely put up some  token election-year opposition and then quietly agree to the expansion.

      Then we will have a whole new set of problems, the quality of care and the amount of corporate and political corruption that will be sowed.

      It's never ending.

      "Don't believe everything you think."

      by BobboSphere on Wed Jul 04, 2012 at 01:03:03 PM PDT

      [ Parent ]

      •  yes, all that money is too (3+ / 0-)
        Recommended by:
        jacey, DavidW, prettyobvious

        much for a Republican not to set him scheming about how to siphon it......

        I wrote a letter to O'Malley suggesting he lure people with the promise of housing so as to capture more medicaid funds and get more people into Baltimore, Cumberland and Hagerstown. We have a huge hospital system in Baltimore and lots of vacant property.

        •  They will refuse--here's why. (2+ / 0-)
          Recommended by:
          Native Light, DavidW

          The GOP has already proven they don't give a damn about  poor people, budget sense, healthcare policy, or sound economics. What they care about is pandering to bigots. Period.

          GOP governors will refuse Medicaid expansion for the same reason George Wallace stood in the schoolhouse door--it's political theater. And it will be similarly effective with their base.

          "The true strength of our nation comes not from the might of our arms or the scale of our wealth, but from the enduring power of our ideals." - Barack Obama

          by HeyMikey on Wed Jul 04, 2012 at 03:01:24 PM PDT

          [ Parent ]

    •  That's old thinking.... (4+ / 0-)
      Recommended by:
      Tam in CA, Native Light, DavidW, Egalitare

      ...unless there is a genuine threat that Republican politicians will be voted out of office in these red states,  they will tell the hospitals and medical lobbies to go pound sand.

      Honey Badger Republicans don't care about pleading lobbyists. They care about the raw pursuit of power. This step gives them power over the outcome of Obamacare. If Obamacare fails, that's what people will remember and it won't matter what the hospital lobbies did or said.

      •  Since health care is 18% of US GDP (3+ / 0-)
        Recommended by:
        divineorder, ferg, Mike08

        let's assume it is 18% proportionately of individual states' GDPs......or more.

        That's larger than any other individual industry residing in any state. Probably too hard to ignore. And if hospitals and providers think they won't get reimbursed for care, they'll make a large stink.

        •  Unless that stink is large enough to unseat..... (3+ / 0-)

          .....a wingnut in a red state, it is quite simply irrelevant and will be ignored. You continue to use reason which ignores the fact that they are not acting in the best interests of the economy, they are simply trying to retain and expand their power.

          They retain and expand their power if they make this President and his programs fail,

          Got it?

    •  Between the medical industry (0+ / 0-)

      and taxpayers--i.e., every other industry--I see the medical "industry" losing. There isn't that much to be made from Medicaid anymore anyway, reimbursement rates were never that great and the only way to profit from it was fraud, which is more likely to be noticed now that budgets are so tight.

      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

      by Alice in Florida on Wed Jul 04, 2012 at 04:31:20 PM PDT

      [ Parent ]

  •  Medicaid expansion (8+ / 0-)

    would provide tremendous financial aid to some great safety net hospitals. A lot of the poor and uninsured people that use them now will likely will stick with what they consider to be their hospital even when they are insured.
    This is a good diary.

    Here is the truth: The Earth is round; Saddam Hussein did not attack us on 9/11; Elvis is dead; Obama was born in the United States; and the climate crisis is real. It is time to act. - Al Gore

    by Burned on Wed Jul 04, 2012 at 12:00:23 PM PDT

  •  Also the converse (7+ / 0-)

    Poor health comes with poverty just as poverty very often comes with poor health...

    "For what profit a man, if he gain the world, but has to pay taxes on it?" -ontheleftcoast, The Book of Paul

    by MsGrin on Wed Jul 04, 2012 at 12:09:23 PM PDT

  •  This is VERY close to a false equivalency (0+ / 0-)

    Of course, I suppose the difference between 26,000 as a budget cut and 90,000 for faulty paperwork MIGHT seem to be the same thing, but they're not. CS or not, I'd get rid of "Bipartisan" in your headline to that section to get rid of any suggestion you're doing anything like this.

    -7.75, -8.10; All it takes is security in your own civil rights to make you complacent.

    by Dave in Northridge on Wed Jul 04, 2012 at 03:07:50 PM PDT

    •  I changed the wording to avoid confusion. (1+ / 0-)
      Recommended by:
      Dave in Northridge

      I was trying to say that attacks from Medicaid have come from both parties: Jerry Brown, Mike Beebe, Andre Cuomo, Chris Gregoire, Jack Markell and Bev Perdue are all Democratic governors who have at least proposed Medicaid cuts of varying severity.

      State Democrats should have proposing Medicaid expansion given the poor state of health among low income Americans.

      The Republicans, of course, were far more savage. In the case of Corbett, his attack on "paperwork" was a sham to get around the PA legislature's reluctance to cut Medicaid.

      "Don't believe everything you think."

      by BobboSphere on Wed Jul 04, 2012 at 07:05:41 PM PDT

      [ Parent ]

  •  Illinois cares- just not for poor people (5+ / 0-)

    And elderly, and disabled. My 72 year old mother, who worked in retail until retiring at age 69- very hardworking, very good at her job, and also incredibly frugal- recently qualified for the Illinois Cares program to pay for expensive medication she needs. Before she was in that program, she worried every month about how she was going to buy the medication and also groceries. I was worried, too, as the medication costs so much that I, a single woman, who lives on very little, was not able to help her out.
    Nor are we black or brown people- its amazing how the GOP have brought their racist dog whistle down and rounded up their loyal followers around this. And how readily and angrily they will deny it when you call them out on it, but everyone can see that is what it is about. They and those who vote for them believe that there are "undeserving" poor (read black and brown people, and anyone who isn't like them. And it will never be them, right? Because they could never lose their insurance, because they work, right?)
    In any event, I happened to be reading a glossy, tri-folding, very nicely designed and printed ($$) pamphlet that came in the mail, I believe it was from Quigley's office, which listed, rather unapologetically, with bullet points, how the Illinois budget problems would be solved. One of the ways was to cut Illinois Cares. I knew my Mom was on it, and I warned her because she had no idea. No letter, no nothing. And sure enough, a few days later, a letter came, the program would no longer exist. Naturally we are worried again.
    Our healthcare system is broken beyond repair. It is very disheartening to watch as our elected officials go about the business of bailing out the banks and billionaires who gambled and lost, and then sacrificing our most vulnerable with absolutely no remorse. Its sick Its sad.
    God help America. Happy 4th.

  •  There was resistance to the original Medicaid (4+ / 0-)
    Recommended by:
    divineorder, BobboSphere, Mike08, MGross

    The governors caved in because of heavy lobbying by Hospitals, doctors, and insurance companies, all of whom are heavy Republicans contributors.

    The last state to cave was Arizona in 1982, just before a referendum on the issue.

    Medicaid funding

    Undaunted, he revived the voter registration campaign and turned to yet another cause: Medicaid funding. Arizona in 1981 was the only state without Medicaid, since the legislature had refused to appropriate money for the state's share of this federal program.

    In 1982, with an initiative petition drive under way and headed for success, the legislature got the message and established a Medicaid program. Kromko and his allies on this issue, the state’s churches, were satisfied and dropped their petition drive.

  •  Regarding the Supreme Court (2+ / 0-)
    Recommended by:
    BobboSphere, Mike08

    I didn't read the whole thing but it's clear Alito, Thomas, Scalia and Kennedy did not support the Medicaid expansion. From what I did read of the summary, it was Roberts joined by Breyer and Kagan for the opinion finding the Medicaid expansion went beyond Congress' authority under the spending clause, while Ginsberg and Sotomayor disagreed about the Spending Clause authority and submitted an opinion that concurred in part and dissented in part. So it was the conservatives plus Breyer and Kagan that formed the majority on the Medicaid issue.

    "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

    by Alice in Florida on Wed Jul 04, 2012 at 04:56:45 PM PDT

  •  I don't know why states would turn this down. (2+ / 0-)
    Recommended by:
    ferg, Mike08

    This is money that is injected right back into local economies.

  •  States have been cutting health care because of (2+ / 0-)
    Recommended by:
    Mike08, BobboSphere

    the budget problems they've been having.  If Obama's proposal to get money to states for teachers, policemen, and firefighters could get passed, it would not only put people back to work, it would help with those state's budgets.

    But of course, the Rethugs in Congress aren't interested.  Besides, it would be paid for by taxing millionaires a little more, and that's something Republican politicians will never do.

  •  this week Senator Mitch McConnell (1+ / 0-)
    Recommended by:
    will be speaking at the Jackson Purchase Medical Center, in Mayfield, Kentucky Friday July 6, 2012. We don't know the exact time yet. Our sources tell us it will be a closed meeting with some hospital staff, not open to the public. So Senator Mitch McConnell have fun sneaking around Kentucky and speaking to the right-wing choir
    so what's the Republicans party up to?
  •  This is going to cause single-payer (1+ / 0-)
    Recommended by:

    to happen that much sooner. The landscape regarding health care is going to radically change over the next 18 months. Today, the repug facists are claiming they don't care about those with pre-existing conditions. What's next?

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