Jonathan Gruber is an MIT economist who worked with Mitt Romney helping to create Massachusett's universal state health care system and also with President Obama on blueprint for the Affordable Care Act. He spoke with Harold Pollack, Faculty Chair of the Center for Health Administration Studies at the University of Chicago recently and had some harsh words for the Republican Party and their anti-ACA fight, particularly their reluctance to support Medicaid expansion, despite the fact that the federal government has budgeted money to pay 100% of the expansion in the first years and 90% after that. (Any underlines are mine.)
"I'm offended on two levels here. I'm offended because I believe we can help poor people get health insurance, but I'm almost more offended (that) a principle of political economy (is being ignored.)...When the Supreme Court decision (left it up to the states whether or not to expand Medicaid), I said, 'It's not a big deal. What state would turn down free money from the federal government to cover their poorest citizens?' The fact that half the states are, is such a massive rejection of any sensible model of political economy, it's sort of offensive to me as an academic. And I think it's nothing short of political malpractice that we are seeing in these states...
..."(Conservative policy makers in these states) are not just not interested in covering poor people, they are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is almost awesome in its evilness."
Most of the states that have refused to expand Medicaid are completely in Republican hands--both legislature and governor. But one fight is different. Virginia's Governor Terry McAuliffe (D), is trying to expand Medicaid for 400,000 poor Virginians who fall into the ACA coverage gap--people who cannot afford the ACA but are not quite poor enough to qualify for Medicaid as it currently stands in Virginia. Mr. McAuliffe is facing Republicans in Virginia's House of Delegates who say they are willing to shut down the entire state government in order avoid the expansion. The Governor even proposed a two-year trial expansion--the period when the federal government would pick up 100% of the cost--which could be canceled if it was unsuccessful. The Republican led House Appropriations Committee killed it in committee.
New York magazine's Dahlia Lithwick call the display in Richmond "sheer nihilism."
vs. The State That Did
Governor Mike Beebe (D) of Arkansas first made sure his state had its own health care exchange. He then approached Arkansas' Medicaid expansion from an new angle. He applied and got permission from Washington, to use the federal expansion money to purchase private insurance through the ACA for those who fell in the gap.
Republicans, determined to undermine anything with the President's name on it, fought against the expansion and, led by House Speaker Davy Carter (R) and Representative Nate Bell (R) continue to fight to have it repealed even after it has become clear that the expansion is working.
Governor Beebe pointed out the positive fiscal effect Arkansas has realized from the expansion: the state has, so far, saved its health care providers $86 million in previously uncompensated care.
But the announcement that came this week from 9th Street Ministries, a free clinic that has been providing free health care to the poor in Representative Bell's home district since 1998, is undeniably the best demonstration of the program's success on a personal level. The clinic, which is sponsored by the First Baptist Church in Mena, serves only those people with no insurance.
Nurse Stacey Bowser who has acted as clinical director said, "Because people are qualifying for insurance coverage through the Affordable Care Act...our free medical clinic will not be needed anymore. We've gone from seeing around 300 people in a month on a regular basis...to 80 people that came through the medical clinic in February, all the way down to three people...in March. Our services won't be needed anymore, and this will conclude our mission."
I understand that the Republican Party stands for fiscal conservatism, but turning their backs on millions of federal dollars--dollars that are already allocated and continue to sit, wasted really--seems an odd way to "conserve." And how do these same Republicans, who claim for the most part to be Bible following, church going Christians, justify their complete disdain for the "least among (us)."
Can it really be so important to them to defy anything "Obama" that they will turn their back on a basic Republican Party principle while selectively dismissing a core axiom of their faith?
Sadly, the evidence says "yes."
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