Healthcare

Killing Your Own Voters to Own The Libs

JM Ashby
Written by JM Ashby

It feels like this shouldn't still be a thing several years after President Obama left office, but it is.

The Obama-era Supreme Court never struck down the Affordable Care Act (Obamacare) in its entirety, but the court did strike down an individual measure that would have required every state to expand access to Medicaid.

Although the federal government did and still does cover the vast majority of the costs associated with expanding Medicaid, Republican-controlled states refused to expand Medicaid while President Obama was in office and many still haven't expanded the program several years after Trump took office.

According to a new study from the Center on Budget and Policy Priorities (CBPP), the consequences of expanding (or not expanding) Medicaid have been significant and the decision has saved lives or ended them.

Prior to Medicaid expansion, the study finds, mortality trends among low-income older adults were similar in states that would and would not later expand Medicaid. But they sharply diverged starting in 2014, the first year of expansion. In 2014 the annual mortality rate for low-income older adults in expansion states fell by about 9 deaths per 10,000 people, compared to similar adults in non-expansion states, with the impact growing each year to about 21 deaths per 10,000 people in year 4. These differences amount to about 19,200 lives saved among older adults in expansion states over four years, and about 15,600 lives lost among older adults in states choosing not to expand. By 2017 the annual impact is more than 7,000 lives saved in expansion states and almost 6,000 lives lost in non-expansion states.

I don't like being downer, but the story of Obamacare and specifically Medicaid expansion are why I do not believe the next president (assuming it's a Democrat) will be able to usher in "Medicare for all" or some equivalent program.

The difficulty of passing legislation of that magnitude through Congress is another matter altogether, but even if you accomplish that you still have to deal with a court system that is even more conservative today than it was under President Obama.

Trump has added two justices to the Supreme Court, both of whom are federalist society cultists who would almost certainly vote against any health care program the next administration passes regardless of how constitutional it may be.

Medicaid expansion -- a program that both saves lives and costs states relatively little -- barely survived. How will expanded Medicare survive?

I personally cannot get too worked up over any of the health care proposals being floated by most Democratic candidates because I don't believe most of them have a realistic chance of happening. The only proposals that have a chance of surviving are proposals that build on what's already in place.

I'm not necessarily saying that's the best option, just the most practical.

  • muselet

    Access to medical care saves lives and, ultimately, saves money. Treating access to medical care as a commodity—which Rs and conservatives generally do—is foolish and expensive.

    The smarter D candidates for president understand Rs will never vote for a Medicare expansion. They understand the Righty loons infesting the federal courts will never uphold the constitutionality of Medicare expansion. Their proposals are aspirational. I’m not much concerned about the details of a plan that will never be seriously proposed, either.

    Unfortunately for the possibility of reasoned discourse, the apparently compelling argument against Medicare expansion is, “Gummint bad! Keep gummint away from medicine!” (I’d give an example from this morning’s paper, but the Daily Fishwrap hasn’t posted it to the website).

    How do you argue against weapons-grade stupidity like that?

    –alopecia

  • gescove

    I admire Warren and Sanders push for Medicare for All. But I fear the vision of perfect will hinder us from achieving the reality of good. I’m reminded of Jane Hamsher at Firedoglake while the ACA was being drafted. She lobbied hard to kill the bill once a public option was excluded. I was sorely disappointed too, but came to realize that too much good would come of the ACA to kill it over the public option kerfuffle.