Monday, July 02, 2012

Republicans hate Obama more than they love America

President Obama’s signature achievement, the Affordable Care Act, is the law of the land and no longer subject to constitutional challenge. This sticks in the craw of some people who want to deny President Obama the credit he deserves. They have few options. One is to elect Mitt Romney, the man whose only accomplish as governor of Massachusetts was it to pass Romneycare, on which the ACA was modeled.

But there is another approach that Republicans can take to undermine Obamacare. They can sabotage it. And, believe it or not, that’s what they are going to try to do.

The Affordable Care Act requires “states to extend Medicaid coverage to non-elderly individuals with incomes up to 133 percent of the poverty line, or about $30,700 for a family of four,” according to a March 2012 report by the Center on Budget and Policy Priorities. The extension of Medicare, if fully implemented will cover nearly 16 million people by 2019. This is a part of how the ACA reduces the ranks of the uninsured.

Under the law, the federal government would cover nearly 93 percent of the costs of the Medicaid expansion from 2014-22, according to the Center on Budget and Policy Priorities. Specifically, the federal government will assume 100 percent of the Medicaid costs of covering newly eligible individuals for the first three years that the expansion is in effect (2014-16). Federal support will then phase down slightly over the following several years, and by 2020 (and for all subsequent years), the federal government will pay 90 percent of the costs of covering these individuals.

According to CBO, between 2014 and 2022, the federal government will pay $931 billion of the cost of the Medicaid expansion, while states will pay roughly $73 billion, or 7 percent.The Supreme Court has said that if states don’t want to expand Medicare, the only thing the Federal government can do about it is withhold the money that it would have given to the states to fund the expansion. And Republicans are hailing this as a victory over government intrusion into their freedom!

In Lousianna, there are 860,000 uninsured people and 340,000 of them could get Medicaid if Louisiana chose to accept the money from the U.S. government, but Governor Bobby Jindal is committed to refusing it. Henry Clay said he would “rather be right than president.” Jindal would rather be a failed vice presidential candidate, and he is willing to be wrong if that’s what it takes.

Consider Texas. The Texas Medicaid program insures 3.4 million Texans today, including children, pregnant women, people with disabilities and those over age 65. The expansion of Medicare would give coverage to another 1.8 million people by 2019. If Texas rejects the expansion of Medicare, they will not have to spend the 7% of the cost of insuring 1.8 million poor and lower middle class people, many of whom are children. For states that are cash-strapped because of the recession, this sounds like a good thing. Especially if you are comfortable with the status quo, which is that in Texas, 22% of kids, and 25% of adults are uninsured.

The problem, of course, is that leaving 1.8 million Texans uninsured is not cost free to the State of Texas. Some of those people will die, for sure, but the impact of that on state finances is difficult to gauge. True, once they are actually dead and buried, they will stop being a burden to the state’s treasury. But in their final stages of life, they may spend much more than the average Texan on health care. And make no mistake about it, the money they are spending is not their own. Rather, it is state funds that pay hospitals for services that are forced by law to provide to indigents. As we said before, Texas is cash strapped and can’t afford that.

Of all the people who would have been insured in Texas but for that state’s stubborn refusal to accept free money from the Feds, only some of them with die. Others will receive services that will end up being billed to the state because they went to hospital emergency rooms and had no means of paying. Some people will put off seeking treatment for as long as they can. Then, their illness will be more difficult to treat, which is to say, more costly. Perhaps they will have spread their disease to others and there will be costs to treat those people.

Some women will be unable to obtain reproductive health care, with the result of more unwanted pregnancies, which in turn, keep families in poverty, and create new consumers of welfare services. Some will get pregnant, by choice or otherwise, and be unable to afford pre-natal care. Of those, some will have babies that are profoundly disabled, dependent upon the State for their entire lifetime.

It may sound cold-blooded to talk about the tragic consequences of people having to do without insurance in strictly monetary terms. Indeed, it is. Our hearts should ache at the pain of our fellow Americans who suffer because they can’t afford medical care. But this is the argument that Republicans put forward.The truth is much more cold-blooded and cruel.

They are willing to let people suffer and die, so that Obama-care will appear to be a failure. This is their hope because they think that it will help elect Mitt Romney. Well, I've got a message for them: Go to hell!

“… and tell ’em Big Mitch sent ya.”

UPDATE: Think Progress has more on this with some shocking numbers.

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