Saturday, June 30, 2012


Abortion is theoretically legal nationwide, but it's widely available in only some states, and it soon won't be available at all in some. Gay marriage will probably soon be legal in many states -- and will probably never be legal in others. Up here in the Northeast, we have gun laws; in most of the country, it's a firearms free-for-all.

And now, as ProPublica, The Wall Street Journal, and The New York Times have noted in the past couple of days, it's quite likely that many states of the Union simply won't go along with the Medicaid expansion in the health care law, thus continuing the process of turning America into two nations engaged in -- to use a phrase I didn't coin -- a cold civil war:
Millions of poor people could still be left without medical insurance under the national health care law if states take an option granted by the Supreme Court and decide not to expand their Medicaid programs, state officials and health policy experts said Friday.

Republican officials in more than a half-dozen states said they opposed expanding Medicaid or had serious doubts about it, even though the federal government would pick up all the costs in the first few years and at least 90 percent of the expenses after that.

... already, governors in Kansas, Nebraska and South Carolina, among other states, have said they would have difficulty affording even the comparatively small share of costs that states would eventually have to pay.

... In New Hampshire, State Representative Andrew J. Manuse said he and other Republicans were already working to block the expansion of Medicaid....
Striking down the Medicaid provision was an act of evil genius, because the middle class never seeks to fight for benefits for the poor. The issue now ceases to be "coverage for everybody" and becomes "coverage for them." Even in blue and purple states, governors and legislators who fight for universal coverage are going to be attacked as evil taxers and job-killers; this is the perfect issue to get another round of Chris Christies and Scott Walkers elected.

Oh, and as Politico notes, there are going to be many Republican refuseniks preventing their states from setting up health care exchanges. This might not mean much -- the feds are supposed to set exchanges for states that refuse to do so themselves -- but it's one more way this law is starting to seem like Brown v. Board or school busing, a federal requirement that's going to lead to massive resistance at the state level.

On the Medicaid front, as the Times reports, there is the possibility that there'll be pressure on reluctant states to go along with the expansion -- and guess what the source will be:
Health care providers who treat low-income patients strongly support the expansion of coverage.

Richard J. Umbdenstock, the president of the American Hospital Association, said that hospitals around the country would lobby for the Medicaid expansion....

Nancy M. Schlichting, chief executive of the Henry Ford Health System in Detroit, said she "absolutely will lobby" for the expansion of Medicaid. She said she expected Gov. Rick Snyder, a Republican, to support the expansion, but she added, "he may have trouble" getting it through the Michigan Legislature.
Is near-universal coverage going to happen only because the fat cats of Big Medicine lobby for it? Maybe.


Never Ben Better said...

Well, it sure as hell ain't us faceless powerless peons who'll get the redstate regressives to do it; so if it takes the lobbying power of the healthcare conglomerates to git 'er done, then bully for them.

Ya know, in fact, maybe forcing them to have some considerable expanse of skin in the game (no denial for pre-existing conditions; can't drop for being sick; no lifetime limits; medical loss ratios, e.g.) rather than trying to freeze them out of it (single payer? Dream on in this dysfunctional world) makes sense after all?

Sator Arepo said...

"Is near-universal coverage going to happen only because the fat cats of Big Medicine lobby for it?"

something something strange bedfellows something something.

: smintheus :: said...

An act of evil genius as well because there was no legitimate reason to rule the expansion of Medicaid unconstitutionally coercive. Medicaid is an opt=in program, and anyway the govt rewrites the rules of programs all the time. No state AFAIK has ever gotten them struck down because it just liked the old rules better.

Victor said...

Too bad the companies didn't express that earlier.

Roberts may have "ruled for the left"* on this one case, but he never doesn't always support whatever it is corporations want.

He must have slipped this one past them without asking "Mother(feckers), may I?"

*I almost got violently iss on Thursday, listening to Chris Matthews going on and on about how Roberts must have sat down and talked to his family about this decision.

I have a love/hate relationship with Matthews, depending on the day and the guest. And this was the latter.
One thing's for certain, he's a whore for the "Big Man/Woman Influencing History" theory. He was almost as effusive in his praise of Roberts and he was of Commander Codpiece Bush prancing around the deck of that aircraft carrier - a show that should haunt him the rest of his days.

Victor said...

Violently ill, not violently "iss."

Kent oui haz "Edit" pleeaz, 'n knot jess dat gargedge kan?

Have a nice few day's off, Steve. Have an ice cold one on me.