Some Republicans want their party to stop bashing poor people as lazy and undeserving of public assistance. Sam Brownback, the conservative governor of Kansas, doesn’t appear to be one of them.
Brownback and his allies are in the middle of a major fight over Medicaid, the government-run health insurance program for the poor and disabled. Historically, most states made Medicaid insurance available only to certain classes of people, such as children and pregnant women. Thanks to the Affordable Care Act, states can now make the program available to all residents with incomes below or just above the poverty line -- with the federal government picking up most of the cost.
But Medicaid eligibility doesn’t expand until state officials either pass new laws or take executive actions -- and in 20 states, conservatives opposed to “Obamacare” have successfully blocked that from happening. Kansas is one of them, with Brownback leading the charge.
Plenty of people in Kansas are unhappy about this. The hospital industry has been begging lawmakers to take the federal dollars -- citing, among other things, the recently announced closing of a rural facility, Mercy Hospital of Independence, in the southeastern part of the state. In response, some Republican lawmakers conceded that maybe it was time for Kansas to join the program.
Brownback is having none of it. And while conservatives who oppose the expansion sometimes rely exclusively on arguments about Medicaid’s efficacy -- or perceived lack thereof -- Brownback has been putting his rhetorical emphasis elsewhere.
On Tuesday, the governor's deputy communications director, Melika Willoughby, distributed a letter laying out in detail the heart of Brownback’s argument -- namely, that expanding Medicaid would be “morally reprehensible” because it would help “able-bodied adults … who choose not to work" and would send money to “big city hospitals.”
Brownback isn’t the only Republican who talks about the poor this way. Late last month, Jeb Bush, the presidential candidate and former Florida governor, said he opposes the Affordable Care Act because he doesn’t want to be the kind of official who wins over low-income and minority voters by offering them “free stuff.” That statement, in turn, echoed comments from the 2012 election cycle -- when former Massachusetts Gov. Mitt Romney (R), Rep. Paul Ryan (R-Wis.), and other leading Republicans had a lot to say about “makers and takers,” as well as “the 47 percent” of Americans who depend upon at least one government assistance program.
But the Brownback administration's letter is particularly illustrative of such rhetoric. Below are some key sections of the text, along with annotations from The Huffington Post to provide some context that the letter leaves out. The full text of the letter appears at the end of this article.
Today, as hospitals nationwide face the ramifications of Obamacare, Democrats are clamoring for an antidote to their self-inflicted wound. They think Medicaid Expansion is the solution. They are wrong. Problems facing rural hospitals are real, but Medicaid Expansion is nothing more than a perpetuation of the original offender—Obamacare.
Contrary to what the letter claims, the "wound" to the Affordable Care Act -- and, by extension, the hospitals now struggling with lost revenue -- was not inflicted by Democrats. It was inflicted by the Supreme Court, and then by Republican officials like Brownback.
The original idea of the law was that reimbursements from newly insured Medicaid beneficiaries would offset cuts to other federal programs. The new arrangement would be more efficient and would keep hospitals financially sound. But in 2012, the court gave states more leeway to opt out of the Medicaid expansion, and now, Republican officials like Brownback are using that leeway to turn down the money -- even though the other cuts are still taking place.
Some hospitals have margins big enough to cover these losses. But some hospitals serving large numbers of uninsured patients do not have such resources. The same goes for some hospitals in rural areas. By the looks of things, Mercy Hospital of Independence -- the Kansas facility that is closing -- is one of these.
Liberals know the political toxicity of Obamacare, so they’ve continued their call for government-run healthcare under the name of Medicaid Expansion.
“Toxicity” is a strong word for a law that, according to the polls, has nearly as many supporters as opponents -- and which contains features that, with only a few exceptions, are wildly popular.
As for the bit about “government-run” health care, advocates for single-payer health insurance would actually love more government control beyond Medicaid expansion. In fact, they were livid when lawmakers stripped the Affordable Care Act of the so-called public option for health care insurance, which would have offered an actual government-run plan to compete with private health insurance coverage options.
Meanwhile, it's not just liberals calling to expand Medicaid. Plenty of conservatives are, too -- because, notwithstanding their general feelings about the Affordable Care Act, they realize that expanded programs can boost state economies and help needy residents get affordable health care. In Arkansas and Michigan, for example, conservative officials agreed to compromise measures that allowed federal money to start flowing.
This masquerading component of Obamacare is riddled with fiscal solvency issues, but Governor Brownback’s primary objection is a moral one: Medicaid Expansion creates new entitlements for able-bodied adults without dependents, prioritizing those who choose not to work before intellectually, developmentally, and physically disabled, the frail and elderly, and those struggling with mental health issues. This isn’t just bad policy, this is morally reprehensible.
Put aside the stuff about “able-bodied adults” for just a moment, and focus on that statement about protecting the mentally ill. It is baffling. As Harold Pollack, a professor of social work at the University of Chicago and leading expert on Medicaid, noted recently in the Washington Post, expanding the program would dramatically increase access to mental health treatments.
And while it’s true that expanding Medicaid would require states to spend some of their own money as the federal investment tapers down from 100 percent to 90 percent over the course of several years, the investment is small -- particularly when you take into account that states with higher Medicaid enrollment can spend less on other programs that directly or indirectly subsidize care for the uninsured.
The math would appear to work out pretty well for Kansas: A 2012 estimate by Urban Institute researchers and published by the Henry J. Kaiser Family Foundation projected that, during the first 10 years of the Affordable Care Act’s implementation, states' extra spending would add up to less than 1 percent of total general fund expenditures. That’s not even taking into account the fact that the extra Medicaid money would also spur economic growth, boosting tax revenues.
In short, there’s no reason to think expanding Medicaid would seriously threaten support for the disabled and other vulnerable groups. If anything, the opposite is true.
...this Obamacare ruse funnels money to big city hospitals, creates a new entitlement class, and fails to rightly prioritize service for disabled citizens. Governor Brownback will maintain his commitment to provide care to vulnerable Kansans before able-bodied adults.
The letter’s most misleading claim, which appears several times, is also its most familiar one. It's the idea that people who would receive Medicaid are primarily “able-bodied adults” who “choose not to work.”
A Kaiser Family Foundation analysis of the population that would gain coverage from expanded Medicaid found that two-thirds of expected beneficiaries live in households where somebody works, and slightly more than half have jobs of their own. Typically, these are people working either in low-wage or part-time jobs, frequently for small businesses that don’t offer coverage. For people living in a household in which no one is employed, at least some and possibly most of them would very much like to have jobs, but they just can’t find them.
Does Medicaid end up subsidizing some people who could find employment, but choose not to do so? Of course. All social welfare programs do. But, by and large, the expansion is going to help individuals and families where somebody is working -- and frequently, working very hard. It could be somebody waiting tables at a diner, or juggling custodial shifts at a shopping mall. The problem is that jobs like these provide neither insurance nor enough pay to cover insurance premiums.
It remains to be seen how Brownback's rhetoric plays in Kansas. The state has never been particularly generous towards the poor. Its existing Medicaid program is among the stingiest in the country, and it's not like voters there were clamoring for a change before the prospect of expanded Medicaid arose. But regardless of the letter's political impact in Kansas, or even beyond, it's a reminder of the way many Republicans still feel about the poor.
Jeffrey Young contributed reporting to this article.
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