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Back in May 2009, the Washington Post touched on the greatest irony of the health care debate just beginning to grip the nation. "The Democrats' No. 1 domestic policy initiative," Alec MacGillis wrote, "is likely to help red America at the expense of blue." You didn't need a crystal ball to see why. The chasm in care and resources was due to "the disproportionate share of uninsured is in the South and the West, the result of employment patterns, weak unions and stingy state governments," MacGillis explained, rightly concluding that health care reform would ultimately "represent a substantial wealth transfer from the North and the East to the South and the West."

Unless, that is, the poorer, sicker and more Republican red states did the unthinkable and said no to the help from their blue state brethren.

Five years later, that tragedy is exactly what has come to pass. While as many as 23 million Americans obtained health insurance during the first enrollment period for the Affordable Care Act, millions more were needlessly left without coverage in the reddest of red states. Because 24 GOP-controlled states rejected Obamacare's Medicaid expansion that virtually pays for itself, seven million residents remain insured. Up to 17,000 of them are projected to needlessly die—every year. By refusing to run their own exchanges, blocking the outreach of "navigators" that Medicare has used with great success for more than 20 years and turning to myriad other obstructionist tactics, states like Rick Perry's Texas, Bobby Jindal's Louisiana and Nathan Deal's Georgia have accomplished what five years ago seemed impossible.

Republicans have made the yawning gap between blue and red state health care worse.

The steep decline in the ranks of the uninsured tells the tale, or at least part of it. Two recent Gallup surveys showed that the percentage of uninsured in the United States dropped from 18.0 percent last fall to 15.6 percent in April, its lowest level since 2008. But most of the newly insured are in those generally Democratic states which embraced Obamacare, cutting their uninsured rates from 16.1 to 13.6 percent, an impressive 2.5 point decline. But the rejectionist red states have hardly moved the needle, with the uninsured rate edging down by only 0.8 percent from 18.7 to 17.9 percent among adults 18 and older.

Those top-level numbers, however, obscure the magnitude of the very real—and completely unnecessary—human suffering in the reddest of red states.   California enrolled 1.4 million people under the ACA, while New York  signed up 900,000 more.  (In the highly regulated Empire State market, premiums fell by half).  But as a new assessment this week from the Kaiser Family Foundation revealed, almost 80 percent of the adults caught in the “coverage gap” reside in southern states.  Two-fifths of them are white.  As dire as KFF’s forecasts  for GOP-controlled states were in January, the reality is still staggering.  Between them, Texas and Florida, two states in which Republicans said no to the Medicaid expansion and impeded just about every other Obamacare initiative they could, those who could been covered constitute almost 40 percent of the national total.

Continue reading about the growing blue state-red state health care gap below.

As Kevin Drum concluded, "Republican governors have been almost unanimously dedicated to sabotaging Obamacare and withholding health care from their own residents, and they've been successful." But Drum actually understates the magnitude of the GOP's betrayal of red states residents. As the data have shown for years, health care is worst in those states where Republicans poll best.
That truism was reflected in Gallup's 2012 poll of the insured in America. With almost 28 percent of respondents uninsured, Texas far and away led the nation as well as the "uninsured belt" that stretches across the solidly red south. Led by Mitt Romney's Massachusetts, nine of the top 10 performing states voted for Barack Obama in 2008 and 2012. But tallying up the ranks of the uninsured understates the magnitude of the health care horror story in Red State America. In its 2009 state health care scorecard, the Commonwealth Fund measured performance in providing health care access, prevention and treatment, avoidable hospital use, equity across income levels, and healthy lives for residents. Again, while nine of the top 10 performing states voted for Barack Obama in 2008 and 2012, four of the bottom five (including Arkansas, Mississippi, Oklahoma and Louisiana) and 14 of the last 20 backed John McCain and Mitt Romney. (That at least is an improvement from the 2007 data, in which all 10 cellar dwellers had voted for George W. Bush three years earlier.)  Texas, which Gov. Rick Perry claimed in 2010 had the best health care system in the nation, is ranked a moribund 46th.
The situation hasn't gotten any better for Red State America. In March 2012, the Commonwealth Fund performed a similar analysis of the nation's 300-plus metropolitan areas. Twenty eight of the top 30 voted for Barack Obama. All of the lowest ranked 10 percent voted for Mitt Romney.
These dismal numbers reflect something else. Republican-run states don't just have the worst health care systems; they are also home to the unhealthiest residents. In 2009, a UnitedHealth Group funded study examined 22 different indicators and similarly revealed that red state residents are the unhealthiest in America. The 2013 edition of America's Health Rankings (produced by the UnitedHealth Foundation) looked at rates on obesity, smoking, diabetes and physical inactivity and found much the same thing.
Given the ongoing health care crisis in their states, red state Republicans should have been eager to embrace the Affordable Care Act. That goes double for the ACA's expansion of Medicaid. Uncle Sam pays 100 percent of the cost over the first three years; after 2017, the states are on the hook for 10 percent of the price tag. Between 2015 and 2024, the CBO recently concluded, the federal government will be paying 95 percent of the total cost. But that estimate does not include costs rejectionist states will run up by having to reimburse hospitals and other health providers for the care of the uninsured. That's why the Rand Corporation and others' assessments concluded that for most states Medicaid expansion will pay for itself. As Ezra Klein summed it up in 2012:
The deal the federal government is offering states on Medicaid is too good to refuse. And that's particularly true for the red states.
Yup, all but one of the 10 states which stood to benefit most by expanding Medicaid to 133 percent of the federal poverty level (FPL) voted for Mitt Romney. Nine of the 10 benefiting least gave their electoral votes to Barack Obama.
But Klein's chart understates the suffering red state leaders would inflict on their own constituents by passing up the Medicaid expansion the Supreme Court in 2010 made optional. As the Washington Post showed in this July 2012 chart, many of the states which ultimately said no to the Medicaid expansion currently offer far stingier programs than their Democratic counterparts.
The rejectionist red states weren't just choosing to leave roughly seven million people without health insurance. They were preserving the option to cut their existing state Medicaid programs further. Phil Galewitz of Kaiser Health News explained one way that could happen:
As a hypothetical example, if Mississippi opted out of the 2014 expansion of Medicaid, poor childless adults wouldn't gain coverage in that state. At the same time, the state could roll back eligibility for parents with children who are currently enrolled, reducing the number of participants in the program.
And as Glenn Kessler explained in the Washington Post in 2011, it is hard to believe that a state like Mississippi could make it current program any worse:
Mississippi provides some of the lowest Medicaid benefits to working adults in the nation. A parent who isn't working can qualify only if annual family income is less than 24 percent of the poverty line. Working parents qualify only if they make no more than 44 percent of the federal poverty level. Seniors and people with disabilities are eligible with income at 80 percent of the poverty line...

Translated from the federal poverty guidelines, that means a working Mississippi couple with one child could earn no more than $8,150 a year and still qualify for Medicaid, seniors and people with disabilities could earn no more than $8,700, and a pregnant woman could earn no more than $20,000 a year.

Ultimately, several of the states listed in the charts above expanded Medicaid. Thanks to Democratic Gov. Steve Beshear, Kentucky established the Kynect program, which has now enrolled 413,000 residents in Medicaid or private insurance. Arkansas Democratic Gov. Mike Beebe turned to a private option negotiated with the Department of Health and Human Services (HHS) enabling 155,000 newly Medicaid-eligible Arkansans to purchase coverage from insurance companies. And while four hospitals in Georgia have already closed because GOP Gov. Nathan Deal refused to accept Medicaid coverage for over 600,000 Peach State residents, in Mena, Arkansas the 9th Street Ministries free clinic is closing its doors after 16 years because its services are no longer needed by the poor residents who have now obtained health insurance thanks to the Affordable Care Act. It's no wonder the private option approach is very popular among Arkansans, unless they are first informed that it is part of Obamacare. (That's also why Kentucky and Arkansas give Obamacare higher marks than Louisiana and North Carolina. Yet, even in those rejectionist states, residents do not want to repeal Obamacare.)
The Republican saboteurs warning their constituents about "death panels" and "chip implants" aren't just leaving millions of their own residents uninsured and hospitals at risk. They are killing people.

That's the conclusion a team of researchers from Harvard Medical School recently published in Health Affairs. The authors of "Opting Out Of Medicaid Expansion: The Health And Financial Impacts" tallied up the coming body count in the Republican states that rejected the ACA's extension of Medicaid to millions of their residents:

Nationwide, 47,950,687 people were uninsured in 2012; the number of uninsured is expected to decrease by about 16 million after implementation of the ACA, leaving 32,202,633 uninsured. Nearly 8 million of these remaining uninsured would have gotten coverage had their state opted in. States opting in to Medicaid expansion will experience a decrease of 48.9 percent in their uninsured population versus an 18.1 percent decrease in opt-out states. [...]

We estimate the number of deaths attributable to the lack of Medicaid expansion in opt-out states at between 7,115 and 17,104. Medicaid expansion in opt-out states would have resulted in 712,037 fewer persons screening positive for depression and 240,700 fewer individuals suffering catastrophic medical expenditures. Medicaid expansion in these states would have resulted in 422,553 more diabetics receiving medication for their illness, 195,492 more mammograms among women age 50-64 years and 443,677 more pap smears among women age 21-64. Expansion would have resulted in an additional 658,888 women in need of mammograms gaining insurance, as well as 3.1 million women who should receive regular pap smears.

To put those findings in terms Republicans can understand, up to 3,000 of Rick Perry's Texans will needlessly die each year. Those dead will joined by up to 671 from Scott Walker's Wisconsin, 1,176 in Nathan Deal's Georgia, 2,221 in Rick Scott's Florida and 1,145 in Pat McCrory's North Carolina.
It's no wonder Ohio GOP Gov. John Kasich got biblical on Buckeye State Republicans to extend Medicaid coverage to 300,000 of their state's residents:
"When you die and get to the meeting with St. Peter, he's probably not going to ask you much about what you did about keeping government small, but he's going to ask you what you did for the poor. You'd better have a good answer."
But thus far, most Republican leaders in Washington and in the states are just doubling down. The party's leaders and presidential aspirants, including Mitch McConnell, Rick Perry, Scott Walker and Bobby Jindal are all campaigning on repealing Obamacare. In Kansas and Georgia, Governors Sam Brownback and Nathan Deal, both facing tough reelection battles, signed laws that shift the decision to accept the Medicaid expansion to the GOP-controlled legislatures. And even as Obamacare  critic Robert Laszewski is urging Republican governors to follow in Arkansas' footsteps, conservative think tanks are turning to bogus math to undermine the private option Medicaid program in place there.

And all the while, the long-standing blue state health care advantage will continue to grow. But it didn't have to be this way. It still doesn't. The health care deficit in the red states will begin shrinking as soon as their Republican leaders stop saying "no" and start saying, "thank you."

Originally posted to Daily Kos on Sun Apr 27, 2014 at 11:20 AM PDT.

Also republished by Obamacare Saves Lives.

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Comment Preferences

  •  Just a heads-up. (7+ / 0-)

    The diary says

    But most of the newly insured are in those generally Democratic states which embraced Obamacare, cutting their insured rates from 16.1 to 13.6 percent, an impressive 2.5 point decline.
    I think you meant cutting their uninsured rate.

    Hey GOP! You'll get my Obamacare when you pry it from my cold, dead hands. And thanks to Obamacare, that just may be awhile.

    by jazzmaniac on Sun Apr 27, 2014 at 11:26:25 AM PDT

  •  By the time 2016 rolls around (13+ / 0-)

    …we will have the "murder by policy" numbers for each of those red state governors who obstructed Medicaid expansion.

    Any of those governors who attempt to run for President will have to account for each of those deaths -- each of those families impacted whose lives were harmed -- because the blood will be on his hands.

    It is an unspeakable evil and a deliberate genocide of a specific and targeted demographic group.

    During the 2016 campaign, they need to be pounded and hounded by the stories of the individuals they killed out of spite.

    If the GOP has the temerity to nominate one of them.

    Let's hope they do, because a murder-by-policy perpetrator is a slam dunk for Democrats.

    •  To bad people will (6+ / 0-)
      Recommended by:
      Pluto, Pinto Pony, TofG, wasatch, hbk, alice kleeman

      have to die before anything changes. Very sad.

      If you are not the lead dog, the view never changes.

      by RepresentUsPlease on Sun Apr 27, 2014 at 11:44:08 AM PDT

      [ Parent ]

    •  It will come back to haunt them for years and (3+ / 0-)
      Recommended by:
      Pluto, wasatch, hbk

      years.  They don't just say they won't expand medicaid because it's big government, etc.  They go on and take such loud, happy pride in it.  The gods are listening, Rethugs.

      Putting the fun back in dysfunctional.

      by hawkseye on Sun Apr 27, 2014 at 01:34:20 PM PDT

      [ Parent ]

      •  I think that is so. (6+ / 0-)

        And there are larger and direct consequences that will impact the entire state. Hospital costs will soar (from ER visits and uninsured patients who are admitted) and the money has to come from somewhere to cover that.

        The Feds won't help so either it comes from sharply increased state taxes or huge premium increases for businesses and individuals in those states. Or, the hospitals shut down.

        That's going to play out fast.

        •  In Texas (1+ / 0-)
          Recommended by:

          They are just saying it is the President's fault. The hospitals had really been pushing and then they just caved. The good news is they are going to get screwdriver. The bad Ned is rural hospitals will be closing like they are in GA.

        •  Particularly since the ACA repealed St. Ronnie's (6+ / 0-)

          law in part, specifically the part that partially reimbursed hospitals when it also required them to treat the uninsured. That reimbursement is now supposed to happen through expanded Medicaid. Hospitals are screaming.

          Some hospitals figured out that they could enroll ER patients on insurance plans and pay their premiums on the spot during Open Enrollment, even without subsidies for those in the Medicaid gap. (No pre-existing conditions, remember.) They can also enroll patients who qualify for existing Medicaid programs even in states without expansions, the so-called "woodworkers".

          So now insurance companies are screaming, first that that was illegal (It isn't) and they don't have to take premium payments from third parties (They do) and then that states have to take Medicaid expansion. (Popcorn!)

          Doctors, pharma, medical device manufacturers, indeed the whole health care industry except a few ideologues and medical fraudsters are demanding that states take the money that would flow to them.

          Back off, man. I'm a logician.—GOPBusters™

          by Mokurai on Sun Apr 27, 2014 at 03:09:27 PM PDT

          [ Parent ]

          •  Your comment (2+ / 0-)
            Recommended by:
            Pluto, Calamity Jean

            Can't be repeated enough. Letters to editors etc. You can only imagine what will happen in Tx where so many working poor remain uncovered.

            If hospitals were smart they would start their own HMO with a qualifying catastrophic plan and enrolled them for 25 dollars to start in November enrollmeny

            •  I don't see how that helps with expensive (0+ / 0-)

              catastrophic care. Becoming an HMO means they still have to pay for the care.

              There are hospitals thinking of turning HMO to get out from insurance payment bureaucracies, but they will start at the high end of the premium scale in order to have profits to plow into expansion. That is what Kaiser is doing in California, so that their existing facilities are not overwhelmed.

              We have been hearing horror stories that HMOs will not be subject to. They do not have to beg and plead with insurers to pay for care they prescribe, or leave patients high and dry after emergency care.

              Aetna repeatedly denies $165k hospital bill of man almost burned to death trying to save girl's life

              Back off, man. I'm a logician.—GOPBusters™

              by Mokurai on Sun Apr 27, 2014 at 09:26:22 PM PDT

              [ Parent ]

      •  no one with health insurance should get away (1+ / 0-)
        Recommended by:

        with saying this. And each time one does, there own safe status and hypocrisy needs to be pointed out

    •  Already happening (2+ / 0-)
      Recommended by:
      BMScott, Pluto

      Most notably in Florida.

      Death by Dogma: Charlene Dill Didn’t Have to Die

      by Alan Grayson for Daily Kos

      The "Obamacare Six" targeted by the Senate Conservatives Fund, supposedly the six most vulnerable Democratic Senate incumbents, are all fighting back on Medicaid expansion and other aspects of the ACA that Republicans want to take away from voters and everybody else.

      Dems and MSNBC fight back on Obamacare

      Mary Landrieu says we don't have a Medicaid Gap, we have a Jindal Gap.

      Similarly for Mark Begich in Alaska, Mark Pryor in Arkansas, Kay Hagan in North Carolina, Mark Udall in Colorado, and Jeanne Shaheen in New Hampshire.

      Alison Lundergan Grimes (not an incumbent, obviously) is hammering Mitch McConnell on Obamacare repeal. Michelle Nunn, running for an open Senate seat in Georgia, is blasting Georgia Republicans on Medicaid expansion and repeal of popular provisions, while distancing herself from the mandate.

      Republicans have been crowing at early and unreliable generic polling showing them with a good shot at taking the Senate, and are about to be blindsided by their own unskewing as the campaigns move forward through the primaries, and Democrats get to be polled against actual Republican candidates.

      Paul "lies from the pit of Hell" Broun in Georgia would be just the sort of unforced error to make mincemeat of the early polling data, like Richard Mourdock, Todd Akin, Sharron Angell, and others before him. Karen "Defund Planned Parenthood/What War on Women?" Handel likewise. David Perdue, former CEO of Dollar General, is polling higher than those two, but shot himself in the foot not long ago by criticizing Handel for not going to college.

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Sun Apr 27, 2014 at 02:57:43 PM PDT

      [ Parent ]

  •  Question say Dems win FL & PA Governor (6+ / 0-)

    but the GOP still control both state's legislations what is the plan by Progressives to get this expansion passed? For that matter look at VA for an example of the problem. With gerrymandered state districts we really need to put our heads together on a way to break this log jam.

    Do we force a confrontation on the budget over this? What are we going to do?

    -1.63/ -1.49 "Speaking truth to power" (with snark of course)! Follow on Twitter @dopper0189

    by dopper0189 on Sun Apr 27, 2014 at 11:43:59 AM PDT

  •  This is an excellent piece, thoroughly researched (5+ / 0-)

    One secondary lesson here is that Democrats are just nicer and more compassionate than Republicans. We extended a helping hand when we didn't have to - and they spit on it

  •  GOP Senate Candidates in IA (2+ / 0-)
    Recommended by:
    Observerinvancouver, wasatch

    running for the open seat being vacated by Tom Harkin have all promised to repeal Obamacare.

    •  Are they exposing themselves in any fora (2+ / 0-)
      Recommended by:
      wasatch, cocinero

      where they can be asked by a mom about coverage for her kids under 26 or asked by someone with a pre-existing condition how they'll get healthcare without going bankrupt? And recorded?  

      We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

      by Observerinvancouver on Sun Apr 27, 2014 at 12:11:48 PM PDT

      [ Parent ]

  •  From a purely cynical perspective, I think the (5+ / 0-)
    Recommended by:
    Egg, Amanda B Reckondwyth, Pluto, wasatch, elmo

    Dems should cool the "human suffering" talk.  The Grinch's heart was two sizes too small; the Republicans' are at least four sizes too small.

    The Dems might make more of an impact by talking economics.  How much federal money are they tossing to the states with exchanges?  How much are they losing because emergency departments are not being reimbursed as much and how many hospitals are having to close as a result?  How many more jobs would their state have by opting in?  How much would state tax revenues go up as a result?  

    How clever do you have to be to create campaign ads with those messages?  

    We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

    by Observerinvancouver on Sun Apr 27, 2014 at 12:00:43 PM PDT

  •  Shame on Republicans for harming Americans (2+ / 0-)
    Recommended by:
    Observerinvancouver, numble

    Shame on Republicans for harming their fellow Americans in the literal, physical, sense, when it could have been prevented. And too bad those being harmed the most are surrounded by Republican propaganda duping them into thinking health care (i.e. what would be available to them through the ACA) is a bad thing so they're likely to keep voting for those who are deliberately harming them.

    Ginny Mayer, Ph.D. Democrat CA State Senate Candidate - SD-35 (Orange County)

    by Ginny Mayer on Sun Apr 27, 2014 at 12:00:44 PM PDT

    •  Not so much (0+ / 0-)

      They are losing millions of young people every year, and are only hanging on through gerrymanders and the filibuster, both of which we know how to overcome.

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Sun Apr 27, 2014 at 03:23:36 PM PDT

      [ Parent ]

      •  Overcoming gerrymandering (0+ / 0-)

        I am glad we know how to overcome gerrymandering - I was not aware of that as it seems to have worked quite well for Republicans thus far as they have hung onto legislatures of states with significant Democratic majorities.

        Ginny Mayer, Ph.D. Democrat CA State Senate Candidate - SD-35 (Orange County)

        by Ginny Mayer on Sun Apr 27, 2014 at 06:41:51 PM PDT

        [ Parent ]

        •  As I said, Republicans are losing millions (0+ / 0-)

          of voters every year, mostly to old age and death in the normal manner, and not replacing them with young voters. That and GOTV, as with Battleground Texas, will do the trick within the next decade.

          Once we have a solid majority in the House and Senate both, we can put through a new Voting Rights Act to fix the Voter ID and other suppression tactics, build a new SCOTUS-proof preclearance list, and mandate non-partisan redistricting.

          At some point, we will reclaim SCOTUS as well. Then the Republicans will be in danger of vanishing away completely, like the Federalists of old, the original Party of No to Thomas Jefferson. It took 18 years for industry and the railroads to create another party of big business, the Whigs.

          Back off, man. I'm a logician.—GOPBusters™

          by Mokurai on Sun Apr 27, 2014 at 09:37:27 PM PDT

          [ Parent ]

          •  Thanks - short term dangers but long-term wins (1+ / 0-)
            Recommended by:

            Thanks for that information - I can see the long term in a more optimistic way. I am in my 60s so I am worried about the short run harm that gerrymandering may bring us -  such as social supports being torpedoed, scientific research and education being defunded, women's rights being curtailed, and war-mongering know-nothings being in charge of foreign policy;  but I am confident that what you describe is indeed the long run so I can take some solace from that.:)


            Ginny Mayer, Ph.D. Democrat CA State Senate Candidate - SD-35 (Orange County)

            by Ginny Mayer on Mon Apr 28, 2014 at 12:17:21 PM PDT

            [ Parent ]

  •  Stop overpaying the Red States! (1+ / 0-)
    Recommended by:

    The Blue states have been paying for the Red States health care and welfare costs while they continue to "bite the hand that feeds them"!  It is time to cut our losses, and say "No!" to these recalcitrant and backwards states.
    Maybe they will learn to shape up, or the people will abandon ship at these state's own self-inflicted abusive behavior by their political elites.
    When will they ever learn?

    •  When I moved to British Columbia more than (0+ / 0-)

      40 years ago, it was a standing joke that road conditions in electoral districts (we call them ridings) correlated with the party that won the districts.  Given B.C.'s geography, road building and maintenance is pretty critical.  I still think it's an abuse of power to play those games.  

      We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

      by Observerinvancouver on Sun Apr 27, 2014 at 12:18:54 PM PDT

      [ Parent ]

    •  But it punishes the people, not the pols (2+ / 0-)
      Recommended by:
      alice kleeman, Calamity Jean

      I don't see a clear way to punish the people with the power to change the decision, except at the ballot box.

      Could the Administration send in federal navigators, kind of a Freedom Summer (1964) effort, to predominantly Democratic areas in the red states, to help people sign up for exchange policies (and the limited Medicaid that's available), and oh by the way are you registered to vote? I realize the next open enrollment period isn't in time to register people for the November election, so maybe it needs to be the reverse -- making sure that people have the information on what they can get for health coverage, even in the states that refuse to help them.

    •  GOP is an Equal Opportunity Killer (1+ / 0-)
      Recommended by:
      alice kleeman

      In the Red States that rejected expanded Medicaid, the GOP governments allow even Republican voters to die unnecessarily. In their demented minds, they must be very proud they allow their citizens the ultimate freedom...To die!

    •  No (1+ / 0-)
      Recommended by:

      We have to turn the narrative around and make it clear to poor Whites that we support them, too, against the 1%.

      Proverbs 25

      Authorized (King James) Version (AKJV)

      21 If thine enemy be hungry, give him bread to eat; and if he be thirsty, give him water to drink: 22 for thou shalt heap coals of fire upon his head, and the Lord shall reward thee.
      Matthew 5

      Authorized (King James) Version (AKJV)

      43 Ye have heard that it hath been said, Thou shalt love thy neighbour, and hate thine enemy. 44 But I say unto you, Love your enemies, bless them that curse you, do good to them that hate you, and pray for them which despitefully use you, and persecute you; 45 that ye may be the children of your Father which is in heaven: for he maketh his sun to rise on the evil and on the good, and sendeth rain on the just and on the unjust. 46 For if ye love them which love you, what reward have ye? do not even the publicans [Roman Revenooers!] the same? 47 And if ye salute your brethren only, what do ye more than others? do not even the publicans so? 48 Be ye therefore perfect, even as your Father which is in heaven is perfect.

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Sun Apr 27, 2014 at 03:34:19 PM PDT

      [ Parent ]

    •  what is at stake (0+ / 0-)

      the lives and deaths of poor people. The people who will die due to this decision are the kind of people who have elected leaders who are trying to suppress their vote.

      The folks that made the decision on Medicaid expansion already have healthcare. We would like the poor in their state to be a little less downtrodden, they would like them to stay as downtrodden as possible.

      That said, I think that it's an excellent idea to organize voter registration drives around this issue. Would be a great idea to do it in all of these states.

  •  Funny and Ironic (5+ / 0-)

    But the same is true for lots of other programs - Blue states supporting the Red states.  I live in a red state and the military bases here are essential along our coast.  Without them the unemployment rate would be through the roof.  We take welfare every year through hundreds of ways - yet my state has drawn the line at the ACA?  Interestingly law makers here do not get the irony.  What is even more infuriating is that there are more Democrats than Republicans. Yet there seems to be no way to vote them out of office.  Last elections there were many more Democratic votes than Republican votes and still we are a deep red state!

  •  Great diary (0+ / 0-)

    I don't think the red state governors are business savvy enough to grasp the deal though.  Somehow, there is an assertion that republicans somehow are strong in business roles.  Here is a flash, they are not.  These clowns are clueless when it comes to a balance sheet or the art of the deal.

  •  It is all workng to plan for GOP (4+ / 0-)

    The fact that few uninsured in red states have benefted from the ACA is exactly what the GOP wanted.

    1. The GOP can remind their voters over and over again that "Obamacare" did not work. Those voters, whose insurance situation is no better or even worse (hospitals and free clinics near them shutting down, for example) leaned GOP anyway and will have no trouble buying into the false narrative that ACA did not work and that the poor in other states that are geting care at their expense!

    2. Few insured under ACA means no one is spreading the word in their districts that democrats and Obama had a good idea, and Republicans were wrong.

    3. Republicans avoid the narrative being about how the GOP wants to take away their new health benefits--because they have none.

    4. Republicans make it harder for democratic opponents to defend their position on ACA in those states and more likely to advocate weakening or abandoning the law for perceived political gain.

    5. They keep the people poor and increasingly beholden to their corporate feudal masters. Don't make waves or try to join a union at work--you could lose your job and the only way to pay for your wife's insulin.

    If only we had a way to reach these voters in red states with the message that the GOP is depriving them and their children of life saving care and better quality of life solely for political reasons.

    If only we could convnce them to vote for their own self interests.

    Wendy Davis' lagging place in the polls for governor of Texas shows you just how futile it is to get conservatives to see through the veil or to vote for their interested, and how hard it is to get nonvoters who support democratic positions to care enough to get to the polls.

    These people in red states who elect the Ghomerts, Cruzes, and Pauls will continue to do so. Even worse, conservatives who are benefiting from ACA are still going to vote for the GOP candidates even if it increases the chance they will lose their new found healthcare or see it taken away.

    Look how many elderly votr for the GOP even though the GOP wants to privatize Medicare and Social Security, leading to deep cuts. It does not help that they have Fox and the Koch brothers brainwashing them with 24-hour propaganda and convincing them that they cannot believe anything they hear from the other side. Even if we could get the message out, these people would dismiss it as lies.

    We cannot even spread the word well in our state. I work with a 40-something Hispanic woman who cannot afford our small company's healthcare, yet she has some joint problems that leaves her in pain and limping. I kept telling her about ACA and how my boyfriend was able to get Medicaid. As of March, she had still not started the process of signing up and kept saying she would do it next week. She had a lot of time to watch TV shows, though. Anyway, now she is stuck waiting until the next open enrollment period.

    It seems like all we can do is wait for these GOP dinosaurs to become extinct. Sadly, many people will die needlesly while we are waiting, and these GOP dinosaurs  have such good healthcare that we pay for that many are going to live a long time.

    **Electing Republicans to the government is like hiring pyromaniacs as firemen. They all just want to see everything burn to the ground.**

    by CatM on Sun Apr 27, 2014 at 12:18:36 PM PDT

  •  Note how close the highend Texas death prediction (1+ / 0-)
    Recommended by:

    is to 9/11 deaths.

  •  Because of the Supreme Court's decision, (3+ / 0-)
    Recommended by:
    Pluto, snoopydawg, waterstreet2013

    they allowed states to choose between participating in the expansion of Medicaid,or forgoing the expansion and retaining the existing payments.  

    Those poor in the red states not only have their governors and state legislators to "thank" for their suffering and for  many their ultimate deaths, but the Supreme Court of the United States.  Shame.

    And, the kicker to this whole vindictive move is many rural hospitals will close because of lack of patients.  It will mean patients who are able to get to the ER of a larger hospital will ultimately find only patch-up treatment will be done.  The bills will be not be paid, therefore, transferring the cost to the insured, wherein, their premiums will rise to compensate.

    And, the deaths that will ultimately result is an unconscionable legacy the likes of Perry, Jindal, and all the rest will leave for posterity.  

  •  the statistic that surprised me (4+ / 0-)

    but I suppose it shouldn't -- is how much of the ACA impact is actually in the Medicaid expansion. We suspected on a gut level that an awfully big chunk of people were in that near-poor (but mostly working) demographic -- not on SSI or something else giving them categorical Medicaid eligibility, but still way too poor to afford health coverage.

    In other words, "poverty" is not just a few people around the edges. It's the built-in persistent condition of something like half the population, more in some states especially the South and West.

    I often think that Republican legislators (both state and Federal) just do not believe the figures of what percentage of their own constituents are in each income quintile, especially how many are in the segment up to 200% of Poverty Line segment. (I suspect that if asked, many would say (1) "I don't know anyone like that" and (2) "The Administration is skewing the figures.") They also seem to firmly believe that all of those people could get $60,000-a-year jobs with full benefits, if only they tried a little harder and had enough incentives to do so.


  •  Don't even THINK (1+ / 0-)
    Recommended by:

    about infringing on my god-given, founding fathers right to be poor, uninsured and sick. The unfettered rights of "corporations as people" to be free of regulation is also being trampled upon by insidious government over-reach.

  •  If they won't take this fed money (2+ / 0-)
    Recommended by:
    txdoubledd, Calamity Jean

    If they won't take this fed money, why do they take all the other federal money?

    Why not pass on say, farm subsidies etc.?

    I would tell you the only word in the English language that has all the vowels in order but, that would be facetious.

    by roninkai on Sun Apr 27, 2014 at 01:22:41 PM PDT

  •  Memo to Corporations (1+ / 0-)
    Recommended by:
    Calamity Jean

    If you want to employ healthy workers, you won't find them in the Red States!

  •  Which states are likely to expand Medicare (0+ / 0-)

    After the election? Maine seems extremely likely, and Pennsylvania likely. Any others?

  •  If I were running the DNCC (3+ / 0-)
    Recommended by:
    madronagal, txdoubledd, Calamity Jean

    what I would do is run a marketing campaign called "I got mine..."

    The campaign would literally be nothing more than persons and families in states that are participating in the ACA/Medicare expansion saying "I got my health insurance coverage thanks to the Democrat's leadership in my state.  Did you get your health insurance coverage?"

    I would run it in deep red districts.

    •  I'd like to see a Republican legislator (0+ / 0-)

      Holding up a health insurance policy and saying, " I got mine - now screw you!"

    •  Door Walking (1+ / 0-)
      Recommended by:
      Calamity Jean

      We should walk door to door with a cheat sheet that would have income up to maximum under Obama care with number in family and show it to them. Ask them if it would have helped them. Then get them to promise to register to vote.  In Tx that should easily be 2 million people.

      Get them to sign a pledge card. We used to find that if you could get someone to take a bumper sticker or contribute even a dollar they would stick with you. We need to get them and we need to stick with them November elections and signup not far away.

  •  MDs in Congress are mostly from worst quality... (0+ / 0-)


    About three-quarters (15) of the 19 doctors in the House and Senate are Republicans. Of these, about three-quarters (11) belong to the Surgical Specialities. What's more, almost all of them come from the worst performing states for healthcare identified by a recent report from the Commonwealth Fund.

    – from a diary I wrote a while back: "Surgeons are Red, Internists are Blue"

    "All politics is national."

    by Auriandra on Sun Apr 27, 2014 at 03:55:39 PM PDT

  •  I just do not understand why (1+ / 0-)
    Recommended by:
    Calamity Jean

    there is not an Equal Protection argument here.  If it does not apply here, then it is a meaningless concept.

  •  The question on my mind, as always, is... (0+ / 0-)

    Why aren't GOP governors and state legislators being made to pay a heavy political price for their obstructionism?  Or really, any political price?

    Have their red-state constituents been so thoroughly brainwashed that they can't even see the huge loss that their own people are being forced to take - just so that their right-wing politicians can make an ideological point?

    Or is it that since Medicaid applies directly only to poor people, and that poor people are typically the least empowered and worst-informed sector of the population (partly because they're constantly preoccupied with just staying alive), their Republican elected officials can exploit their powerlessness and ignorance?

    (I think I just answered my own question.)

    All that is necessary for the triumph of the Right is that progressives do nothing.

    by Mystic Michael on Sun Apr 27, 2014 at 06:36:15 PM PDT

  •  Red, Blue, I DON'T CARE! (0+ / 0-)

    This "great plan" still perpetuates the most corrupt, inefficient health-care system in the civilized world.
    Granted, it's probably the only scrap (trickle) we could get from the corporate behemoth, which has created this bloated system which only serves them well, but the rest of the civilized world is still laughing.
    They are competing WITHOUT the added cost of employee or retiree health care!

    Tough to move when the health/insurance industry has your balls in a vice.

    "To succeed in life, you need two things: ignorance and confidence." - Mark Twain

    by CaptainAnalog on Mon Apr 28, 2014 at 10:31:46 PM PDT

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