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July 05, 2012 11:58 AM Resistance To Medicaid Expansion Not About the Money

By Ed Kilgore

Greg Sargent usefully points to a 2011 Urban Institute study showing that initial estimates of state costs associated with ACA’s Medicaid expansion don’t take into account a variety of state savings (mainly from existing beneficiaries being shifted into higher-federal-match categories of the program, and also from new Medicaid eligibility for mental health patients now receiving purely state assistance) that could actually make the overall package a fiscal plus.

This data will provide valuable ammunition to those fighting efforts by GOP governors and legislators to opt out of the expansion. But I wouldn’t assume it’s any sort of game-changer. You can expect the Jindals and Haleys and Perrys to ignore or dismiss such estimates as biased or unreliable, just as Republicans have almost universally scoffed at the CBO estimates “scoring” ACA as a federal deficit reducer. Another problem is that Republican pols typically claim that the existing Medicaid program as fiscally unsustainable, so they won’t accept it as a baseline for what is tolerable in the future.

But more importantly, we have to remember that this is an ideological and even a moral issue to conservatives, who view dependence on any form of public assistance as eroding the “moral fiber” of the poor (as Paul Ryan likes to put it), and as corrupting the country through empowerment of big government as a redistributor of wealth from virtuous taxpayers to parasites who will perpetually vote themselves more of other people’s money. This line of “reasoning,” of course, would justify the abolition of Medicaid, not just a failure to expand it, but conservatives are careful (and smart) to disguise that ultimate goal and simply suggest we have reached some sort of welfare-state tipping point beyond which we become Greece.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

Comments

  • Ken Doran on July 05, 2012 12:16 PM:

    "But more importantly, we have to remember that this is an ideological and even a moral issue to conservatives, who view dependence on any form of public assistance." I'm not so sure. You don't see them pushing to abolish Social Security, Medicare, or the VA, do you? Remember the Bush Medicare expansion? It is mostly about hanging a defeat on a Democratic president; also catering to interest groups that benefit from flaws in the current system. You do them an unwarranted favor with "moral issue" palaver.

  • castanea on July 05, 2012 12:31 PM:

    The behavior of Republicans and rightwingers makes me think of a quote by M.L. Keene regarding true-believer syndrome:

    "No amount of logic can shatter a faith consciously based on a lie."

    A democracy like we have in America thrives when debate is open, honest, and based on facts. It shrivels and dies when one side of the divide derives its beliefs from certifiable lies and exhibits no desire to change when presented with the truth.

  • Area Man on July 05, 2012 12:39 PM:

    It's also about spitefulness. It's a way to prove to the base that you're going to resist the Kenyan atheo-muslim socialist usurper, and that nothing, including the well-being of your citizens or respect for the law (especially not those things), is going to get in your way. This is how you establish your loyalty to the conservative cause.

  • stevio on July 05, 2012 12:57 PM:

    Can't you just image a spiteful, hating, uppity, Jesus running around Palestine screaming that the poor have too much already, what with sandals, robes and food supplied by those hedonistic Romans and all.

    These Christian dorks that make up the vast majority of low information voters are in for one "hell" of a surprise when they finally meet the guy who championed the meek, the powerless, and the hungry. Something about the eye of a needle...or something...

  • c u n d gulag on July 05, 2012 1:05 PM:

    Oh, they pine for the "good old days," as if America was a cross between "Leave it to Beaver," or "The Andy Griffith Show."

    Somehow, in the 1950's and 1960's, we paid off the governments bills for The Great Depression, WWII, and The Korea War - all while building nationwide super highways, and national and international airports.
    And managed to wage a "Cold War," and planning for, and succeeding at, landing men on the moon.

    Middle class people had enough money, not only to live fairly well, but also wonder why black people and women weren't given the same privileges as white males? Certainly NOT all - but enough.
    So, the Civil Rights Acts were passed.
    The ERA Amendment was proposed.

    And there was enough money lying around not only to keep funding SS well, but also start Medicare and Medicaid - all as part of "The War on Poverty." And, unfortunately, The Vietnam War.

    And how did we do all of that?
    PROGRESSIVE TAXES!!!

    There's nothing America can't accomplish, if people just paid their fair share - like their parents and grandparents did.

    But all of that involved having the rich pay their fair share. And they looked at the 1960's and early 1970's, and decided too many poor people, black and brown people, and women, were getting MORE than THEIR fair share.
    And we're still in part of their backlash.

    so, today, we sit around in a decaying nation, whining about how there no money to do anything, and about how, if we only lower the taxes enough on "The Job Creators (aka - Cannibal Capitalists)," they'll soon tinkle down some of their money in the form of jobs.

    Well, that's bullsh*t!
    I ain't that stupid.

    Too many people are waiting for the rich to shower down some of their money in the form of jobs - instead, they're laughing as they're getting off on giving the rest of us "golden showers."

    Don't piss on my head, rich assholes, and tell me it's rain trickling down.

  • jjm on July 05, 2012 1:07 PM:

    to @stevio: the "Family" of C Street fame (aka "the Fellowship") that counts many GOP congressmen among its adherents DO believe that Jesus HATED THE POOR. He favored dictatorship over democracy (remember Inhofe was it, waving around the picture of an African dictator who has lost his presidency in a democratic election, yelling at the Congress to back the defeated dictator instead, saying, "Look at his face! He's a lovely guy!").

    Following Avram Vereide's 'vision' in the 1930s not only these congressmen but many captains of industry were convinced by this Norwegian immigrant that Jesus hated the poor, that only the wealthy were favored in Christ's eyes, and that every manner of social program (and especially the New Deal) had to be fought against with ferocity.

  • Alan Robinson on July 05, 2012 1:15 PM:

    It's more than philosophy. GOP support or opposition to this policy reflects who gets benefits. If uninsured are Democratic voters, why should a Republican politician support the extension? That is why Social Security and Medicare are tougher, GOP voters benefit.

  • meander on July 05, 2012 1:37 PM:

    "But more importantly, we have to remember that this is an ideological and even a moral issue to conservatives, who view dependence on any form of public assistance as eroding the “moral fiber” of the poor "

    In this ideology, however, the mortgage interest tax deduction, the carried interest loophole and other tax expenditures that favor the middle and upper classes are nothing but good for the beneficiaries' "moral fiber."

  • zandru on July 05, 2012 1:45 PM:

    Ken Doran asks "You don't see [Republicans] pushing to abolish Social Security, Medicare, or the VA, do you?"

    Only if you haven't been watching. The centerpiece of the Paul Ryan budget is changing Medicare into an everyone-buys-their-own-individual-health-insurance-policy "program" which retains the name "Medicare."

    The last major push to abolish Social Security was during the Junior Bush second term and involved changing an insurance program into everybody-sets-aside-money-in-a-private-investment-account "program" which retains the (sadly ironic) name of "Social" Security.

    The VA? Well, this has been even lower key, but there's a move to try and make veterans buy their own personal/family health insurance policies on the open, individual market. I mean, just LOOK at all the money the federal gummint has had to spend on injured vets!

    It's a moral issue, all right. The reactionary right has made selfishness their hallmark, their highest goal (along with greed). If we on the left are smart, we'll work hard to expose this ugly, unChristian foundation to rightwing philosophy and programs.

  • Theda Skocpol on July 05, 2012 2:06 PM:

    Liberal bloggers and commentators are WAY over-hyping this issue. We are at the cheap talk phase, where GOP governors are just posturing in an election season, long before their states really have to decide whether to expand Medicaid. In essence, liberals are helping the right-wingers do their own hype.

    The entire key to this part of health reform and all others is whether Obama and/or one Dem-controlled chamber of Congress emerges from election 2012. Liberal bloggers are doing their bit to make this less likely by never talking about the good specifics or developments in health reform, or the good prospects.

  • jjm on July 05, 2012 2:40 PM:

    To @Theda Skocpol: BRAVO for your comment!

    I was furious the other day over at Daily Kos where the 'progressive' bloggers were re-litigating the ACA, acting as they did when it was still a bill, discussing how to change this or that part of it ... a ridiculous thing to be doing right now (if it ever was anything but ridiculous). They harped on things that were wrong with it (as so many did while the bill was making its way through Congress) with some claiming it was just a 'windfall' for health care providers (?!).

    Since the GOP still automatically refers to the ACA as a bill, not a law, it is very important for Democrats to draw attention to it. How many low information voters think it is still in progress?

  • Duge on July 05, 2012 8:01 PM:

    "This line of “reasoning,” of course, would justify the abolition of Medicaid, not just a failure to expand it, but conservatives are careful (and smart) to disguise that ultimate goal and simply suggest we have reached some sort of welfare-state tipping point beyond which we become Greece."

    Yeah, Christian compassion for "the least among us" is soooooooooo outdated- according to conservatives!