Culling the Herd

A powerful conservative backlash to the Affordable Care Act, pejoratively referred to as “Obamacare,” has created a rather strange healthcare access pattern for the disadvantaged. With more than a little help from the Supreme Court, states have had the option of creating an expanded Medicaid system… or not. Folks in more liberal states have been given broader access to Medicaid; poorer members of conservative states are not so lucky. Strangely, people surveyed in conservative states have generally responded favorably when the benefits of the Affordable Care Act are presented but extremely negatively when the label “Obamacare” was applied to those same benefits.

With virtually all GOP candidates running on a platform of repealing the Affordable Care Act, that would  leave millions of Americans in the lurch, sending the insurance industry into chaos. The few minimalist plans that have been advanced by one or two Republican presidential hopefuls would create a hellish reduction or elimination of healthcare coverage for a whole lot of people. Those with enough money would be safe; those in the middle (without employer coverage) and bottom would find severe new healthcare challenges. And those in the new gig economy would be left to drift.

What would that transition out of the Affordable Care Act look like? We may have the ability to find out. One conservative state, Kentucky, had braved the opprobrium of the right wing world by expanding their Medicaid program against the tide of denying such expansion in GOP-dominated states. 425,000 Kentucky residents found relief in new Medicaid coverage. But that state just elected a new right wing governor, Matt Bevin, who is committed to dismantling that program in his state.

“Now, with Mr. Bevin promising to ‘repeal the expansion as it currently exists,’ Kentucky may become a laboratory for the kind of rollback that the law’s opponents have so far only dreamed of… Nationally, both parties saw the governor’s race as a crucial political test for the Affordable Care Act months after it survived a second major challenge before the Supreme Court.

“Republicans were elated by Mr. Bevin’s sound defeat of Jack Conway, the state’s Democratic attorney general, seeing it as a blatant rejection of the health law and proof that it remains a giant liability for Democrats heading into 2016. Mr. Bevin won all but a few counties, including those with the largest percentage of residents on Medicaid.

“For Democrats, Mr. Conway’s loss illustrated the challenges they may face motivating voters in next year’s presidential and congressional races, not least those the health law is helping. Low-income people, the beneficiaries of the expanded Medicaid program, are the least likely to vote, research has found. And the turnout this month in Kentucky, one of the poorest states, was particularly low: 31 percent.” New York Times, November 27^th.

Is Kentucky heartless enough to dump that segment of its population or is there an interim step they might consider? Is this a fiscal “affordability” issue or something more? Is Bevin softening enough to consider an alternative? “One state that may offer a view of their future is neighboring Indiana. There, Gov. Mike Pence, also a Republican, agreed to expand Medicaid to people earning up to 138 percent of the poverty level, but only after winning federal permission to impose requirements on recipients that go well beyond the program’s normal rules.

“Most significant, Indiana requires enrollees with incomes above the poverty level to make monthly payments, averaging about $11, toward their coverage. If they stop making these payments, they can lose dental and vision coverage or even be dropped from Medicaid temporarily.

“For now, Kentuckians on Medicaid owe nothing for their coverage except minimal co-payments, typically $1 to $4, for certain drugs and services. But Mr. Bevin has repeatedly pointed to Indiana as an example of how Medicaid should work.” NY Times.

It’s hard to believe that a Republic president working with a Republican Congress would simply terminate what millions of Americans have come to rely on for healthcare, both the paid insurance plans and Medicaid. And if affordability is an issue, would a GOP-controlled federal political system address the cost issues – like the free pass to the pharmaceutical industry from having to negotiate over prescription costs with the healthcare exchanges – that plague the attempt to control rising medical costs? Kill the program entirely? Give even more corporate interests their own free passes? Time will tell. But it may well be a measure of how kind or cruel we are to our own.

I’m Peter Dekom, and I find myself at a loss over the deeply imbedded push against kindness and charitable behavior by so many of those claiming Evangelical values.