Partly as a byproduct of conservative optimism about rolling back Obamacare and partly in conjunction with the Republican Governors Association meeting going on in Phoenix, there’s a lot of buzz right now about Medicaid expansion becoming (if it has not already become) a litmus test for conservative orthodoxy and also for acceptability as a 2016 presidential candidate. It’s no coincidence, of course, that one of the governors who did accept the expansion, Chris Christie, is the early MSM/Republican Establishment favorite for putting the Tea Folk back in their place and retaking the White House.
It’s worth accentuating that the Medicaid expansion issue has relatively little to do with the broader controversies over Obamacare. No one is being forced to drop private health insurance to enroll in Medicaid. No one can claim the president “lied” about Medicaid eligibility. The performance or non-performance of HealthCare.gov isn’t really an issue. The pace at which eligible folks sign up mainly just affects them. And there’s no “premium shock” associated with the Medicaid expansion.
And that is sort of why the issue makes the perfect ideological litmus test: opposing the expansion can’t be and isn’t being justified as a prudent objection to an unworkable program or as disruptive to the health care status quo. Yes, opponents whine about future fiscal obligations if and when the federal “super-match” that makes the expansion virtually free to participating states is allowed to expire (or is repealed), but that’s an almost abstract concern given the strong interest among Obamacare’s designers in increasing, not decreasing, the federal role in a more standardized Medicaid program.
So in many respects, states refusing the Medicaid expansion are doing so on grounds that they don’t want their own citizens to benefit from it. And since opposition has centered in the South, there’s not any real doubt a big motive has been a continuation of that region’s longstanding effort to–choose your verb–(a) reduce dependence on government among, or (b) keep down–those people.
As Timothy Egan argues today in a New York Times op-ed:
By refusing to expand health care for the working poor through Medicaid, which is paid for by the federal government under Obamacare, most of the old Confederacy is committed to keeping millions of its own fellow citizens in poverty and poor health. They are dooming themselves, further, as the Left-Behind States.
And they are doing it out of spite. Elsewhere, the expansion of Medicaid, the health care program for the poor, has been one of the few success stories of Obamacare. It may be too complicated for the one-dimensional Beltway press. Either that, or it doesn’t fit the narrative of failure.
They are doing it out of spite. There are nicer ways of saying it, of course. A significant portion, probably even a majority, of conservative activists subscribe to the “tipping point” theory–reflected in Mitt Romney’s famous “47%” speech–that power-mad elites are deliberately using government benefits to create a permanent constituency of serfs among morally corrupted Americans–mostly minorities and young people–who won’t take responsibility for their own lives. Unlike resistance to the Obamacare exchanges, the resistance to the Medicaid expansion is a pretty clear expression not of fiscal concerns or alarm over the impact on insurance premiums or even of hostility to government involvement in health care, but a moral objection to expanded public health care coverage.
So yes, it will be a litmus test, especially when the 2016 presidential nominating contest heads south. If Chris Christie doesn’t “get” that fighting the Medicaid expansion is the latest front in the long civilizational battle of “decent” southern white folks to avoid being overwhelmed by the emboldenment of “those people” by manipulative Yankee elitists, then he’s hardly to be trusted with the presidential nomination of God’s own party. It’s a pure meanness litmus test, and it could be a lot more powerful than the misgivings about Romneycare in 2012.