“It really is just almost awesome in its evilness.” The tragedy of the lack of Medicare expansions

Thank you Harold Pollack and Jonathan Gruber:

Reports of ACA demise: greatly exaggerated 

After Obamacare's open enrollment, Jonathan Gruber shares his optimism, but also disgust over Medicaid expansion 'tragedy'  

By Harold Pollack April 8, 2014

This is the part that sticks in my throat:

“One tragedy deserves attention

Jon: I think, Harold, the single thing we probably need to keep the most focus on is the tragedy of the lack of Medicaid expansions. I know you’ve written about this. You know about this, but I think we cannot talk enough about the absolute tragedy that’s taken place. Really, a life-costing tragedy has taken place in America as a result of that Supreme Court decision. You know, half the states in America are denying their poorest citizens health insurance paid for by the federal government.

So to my mind, 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 there’s a principle of political economy that basically, if you’d told me, when the Supreme Court decision came down, 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 and we’ve got to emphasize that.

Harold: One of the things that’s really striking to me is there’s a politics of impunity towards poor people, particularly non-white poor people that is almost a feature rather than a bug in the internal politics in some of these states, not to cover people under Medicaid, even if it’s financially very advantageous to do so. I think there’s a really important principle to defeat this politically, not just because Medicaid is important for people, but because it’s such a toxic political perspective that has to be … It has to be shown that that approach to politics doesn’t work because otherwise, we will really be stuck with some very unjust policies that will be pursued with complete impunity in some of these places.

Jon: That’s a great way to put it. There’s larger principles at stake here. When these states are turning – not just turning down covering the poor people – but turning down the federal stimulus that would come with that.

Harold: Yeah.

Jon: So the price they are willing … They 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 just almost awesome in its evilness.

Harold: Yeah.

Jon: I agree there, we have to recognize there are larger principles at stake here.

Harold: By the way, one of the real ironies is an awful lot of the institutions that would get the checks from Medicaid are in the public sector. There are also every city and county and correctional system and public hospital desperately wants this.

Jon: Yeah.

Harold: From Texas, Harris County and the City of Houston, they desperately need that money. Maybe what becomes a political forcing event will be some public hospital going out of business or something like that that really, that forces them to think differently, or maybe that just we have to wait until President Obama leaves office because it’s the centerpiece of his presidency and it’s just too hard to do while he’s sitting in that chair.

Jon: Harold, if we look at the original expansion of Medicaid, it took about five years to get all the states in. Really, we’re sort of proceeding at a similar pace. For the first few years, they didn’t even have half the states. So I think we don’t have to panic at this point. History does suggest that we can overcome this, but it’s just very sad along the way.”

The tragedy of the lack of Medicare expansions begins at:

9:41

for anything in any meaningful way. Jon: I think, Harold, the single thing we