Notes on a Theory…

Thoughts on politics, law, & social science

The Impact of Limits of Medicaid Expansion

with 4 comments

As I noted earlier, the big question at the moment is what the potential impact of the limits the Court imposed on the ACA’s Medicaid expansion, which extends to all adults earning less than 133 percent of the poverty level.

David Cole, who I respect a great deal, has thing to say in The Nation

It seems unlikely that states will turn down those funds. Under the ACA, the federal government initially covers 100 percent of all new Medicaid costs, and while the federal contribution  diminishes over time, it never falls below 90 percent of the program’s cost, so any  rational  state will likely take the money and expand its coverage.

I don’t see what that last statement has to do with anything. If your goal is to ensure insecurity, to provide punishment to those at or near the bottom, then the fact that the federal government will mostly pay for achieving a goal you don’t share is irrelevant.  Since breaking the budget to justify further cuts to things like health care, education and public employee pay & benefits is a standard strategy among Republicans in the states right now, this seems to have the logic exactly backwards. This statement is not an outlier, but it seems to reflect an all too common mistake–assuming that conservatives and progressives share the same goals but disagree on means.  I’d suggest reading Cory Robin‘s most recent book to fully understand how mistaken that is. (Robin has some great posts which include excerpts from the book that discuss Justice Scalia that are very timely).

My concern  is articulated well in a post entitled Beyond the mandate: Court’s ruling on another ACA provision could have sweeping implications by Ned Resnikoff:

As Lean Forward reported earlier, George Washington University law professor Jonathan Turley believes that the Medicaid decision could spell disaster for health care reform:

“This creates a ripple effect,” Turley said on MSNBC. “A majority of states oppose this law. If they had an ability to opt out, they would. I don’t see how the health care law could survive if the pool is reduced by that amount. You need to force young people to buy health insurance since they’re not going to get sick as often and (having them in the pool) makes it more affordable.”

Note the issue here isn’t just these individuals, but the impact leaving them out could have on everyone else.

Like I said, this history isn’t written yet.  Whether it’s implementing the law, or expanding it in the future, what happens will be a result of politics,of agitation.  If only one side mobilizes, they have the advantage.

Written by David Kaib

June 28, 2012 at 5:14 pm

4 Responses

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  1. Not sure I agree with your statement that the Federal government paying states’ cost to participate in expanded Medicaid coverage is irrelevant. The account I read in the Washington Post described it as the carrot, while the Court decision took away the stick. Sounds right to me. But I think I understand your concern about the states having been taken over by the extreme wing of the GOP, which stops at nothing to further their agenda – defeat Obama Dems and work for the interests of the 1%. Still, real economics may come to bear on the situation if enough people in the states realize what their state government is throwing away,


    June 28, 2012 at 8:01 pm

    • Well it’s less that I think it is irrelevant, than that I think it won’t be decisive for those Republicans that are ideologically and politically opposed to the goals of ensuring broad access to health care.

      That said, I think the common idea that the Republicans are unmovable is not true. On the few occasions when people have actually mobilized, Republicans have backed down and we’re seen (temporary) shifts in our discourse. A good deal of their power is a product of never facing serious, sustained resistance.

      David Kaib

      June 28, 2012 at 11:37 pm

      • Agree…on local news this morning I just heard the House GOP is planning a vote July 11 to repeal the Heath Care act…they are relentless.

        Michele Kelly

        June 29, 2012 at 6:07 am

  2. […] worth, I was objecting to liberal claims that the Medicaid expansion would happen without a fight back in June 2012. One could argue that it will happen eventually so there is no need to worry about it, but that […]

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