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The past week brought two big waves of Obamacare news. In the first, Maryland became just the latest state to announce that its new health care exchange will deliver lower than expected insurance premiums beginning in 2014. In the second, a slew of contenders for the 2016 Republican presidential nomination took the op-ed pages to denounce the Affordable Care Act (ACA). The latter were nothing if not ironic. On the Fox News web site, Florida Senator Marco Rubio demanded that Congress refuse to fund Obamacare, only to then charge that the resulting government showdown would be the President's fault. Meanwhile, Republican Governors and White House rivals Bobby Jindal and Scott Walker called for a "complete repeal" of the "unworkable Obamacare" even as they insist on denying health insurance to half a million people in Louisiana and Wisconsin.

From the opening sentence of their Wall Street Journal jeremiad, Jindal and Walker went on the attack. "Remember when President Obama famously promised that if you like your health-care plan, you'll be able to keep your health-care plan?" they wrote. "Turns out, the statement is untrue." (Of course, that's not what Obama promised. As the President explained during a joint session of Congress in September 2009, "If you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.") Then they offered these nuggets of wisdom:

If the experience of those working with the ObamaCare implementation at the state level had been taken into account, progress might have been possible, but the administration has treated states with mistrust...

Governors have firsthand experience with implementing public-assistance programs. We know how important it is to care for our most vulnerable citizens and to ensure that people are healthy and able to work. We also know that a one-size-fits-all approach like ObamaCare simply doesn't work. It only creates new problems and inequalities. That's why if you look at all 50 states, you'll see 50 unique ways of handling Medicaid.

Of course, when it came to accepting Obamacare's expansion of Medicaid, Governors Jindal and Walker handled it exactly the same way.

Their approach was to simply say "no" to funding from Washington that would have provided health insurance to almost five hundred thousand more of their residents.  As the New York Times explained in June, Minnesota and Wisconsin provide a useful case study. While Democrat Mark Dayton will be cutting the ranks of the uninsured by almost half in his state, in Madison Republican Scott Walker is leaving an estimated 182,000 folks out in the cold. The situation is even more dire in Louisiana, a state with an estimated 938,000 uninsured today. Had Jindal accepted the Obamacare Medicaid expansion, a recent study forecast, the ranks of the uninsured in his state would have plummeted to 471,000 beginning in 2014. Instead, 772,000 will be left without coverage.

Earlier this month, Jindal used another op-ed to complain that "even advocates for Obamacare admit the federal subsidies are front-loaded and that expansion will eventually cost the states." It is certainly true that Washington is covering 100 percent of the Medicaid expansion through 2017 and only 90 percent above that. But as the RAND Corporation found in a June analysis, the math shows that rejecting Medicaid expansion is a terrible deal for the states. Ezra Klein and Evan Soltas summed up why:

The study, by the Rand corporation, looks at the 14 states that have said they will opt out of the new Medicaid funds. It finds that the result will be they get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.

So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That's a lot of self-inflicted pain to make a political point.

A lot of pain, that is, for over 480,000 people in Wisconsin and Louisiana, and about 11 million total in the 24 states similarly saying to Obamacare out of spite.

Originally posted to Jon Perr on Sun Jul 28, 2013 at 12:19 PM PDT.

Also republished by Louisiana Kossacks and Badger State Progressive.

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