It’s Medicaid, stupid

Democrats are getting a lot of things right in the health care debate. For instance:

  1. Talking about pre-existing conditions. People don’t believe insurers should be able to deny coverage based on pre-existing conditions.
  2. Pointing out that it’s not really a “health care” bill but rather a tax cut bill benefiting the rich.

But they need to talk more about Medicaid, which is the most important part of Obamacare. About 60% of those who gained coverage got it through the expansion of Medicaid. These are not people who were forced to buy insurance. They were just people who couldn’t afford it.

States that accepted the Medicaid expansion, which is 90% funded by the feds, saw their uninsured rates plummet. Hence the major drops in some of the poorest states in the country –– Arkansas, Kentucky, West Virginia.

Sadly, the Medicaid expansion never fulfilled its promise due to a number of cynical Republican governors who sought to politically profit on the backs of the poor. Scott Walker, who was gearing up for what he believed would be a GOP presidential primary shaped by tea party purists (as opposed to Trumpists), led the charge. Rather than embrace the federal funding, Walker forced those with incomes between 100% and 138% of the federal poverty level to buy insurance through the Obamacare exchange, claiming that they’d be better off there and that that would allow the state’s Medicaid program to only focus on those living in poverty. For a little bit of context, 100% of FPL = $11,800 for a single person or $24,300 for a family of four. The idea that somebody with an income a dollar higher than that could afford their own health insurance is ridiculous, but Walker didn’t care.

Alas, all of those allegedly non-poor folks who were denied Medicaid in Wisconsin and in many other GOP-controlled states were not able to buy insurance through the ACA exchange. That’s because they were too poor to qualify for the subsidies needed to afford the plans. Why? Because the ACA, as passed in 2010, did not contemplate that governors would reject the Medicaid funding. The expansion became optional only via a 2012 Supreme Court decision. Of course, by the time that happened, the folks in control of Congress were more interested in sabotaging Obamacare than fixing it, so the country was left with what is now known as the “Medicaid Gap.”

The good news is that not all Republicans were as heartless as Walker. There were a number of GOP governors that embraced the expansion from the beginning, notably John Kasich of Ohio, Jan Brewer of Arizona, Brian Sandoval of Nevada, Susana Martinez of New Mexico and Jack Dalrymple of North Dakota. A few others, including Iowa Gov. Terry Brandstad, Michigan Gov. Rick Snyder and then-Indiana Gov. Mike Pence, embraced the expansion but put in place rules that allowed them to charge Medicaid beneficiaries modest premiums, among other things.

As the successes of the Medicaid expansion became clear, some of the GOP-controlled states that had resisted it began to re-think their opposition. State lawmakers in Montana finally embraced it. The GOP-controlled legislature in Kansas approved expansion but was stymied by their awful governor.

But more importantly, the successes of Medicaid expansion have made members of Congress re-think their position. Shelly Moore Capito of West Virginia knows how much good the policy has done for the people who elected her. So does Dean Heller of Nevada and Lisa Murkowski of Alaska.

The debate over Medicaid is not complicated. Medicaid is the government providing health care to people who can’t afford it. The moral argument in favor of it is rather straightforward.

Of course, many Democrats are tempted to avoid talking about “poor people” issues in favor of ones that they believe have broad appeal to the middle-class. Hence the focus on contraception and pre-existing conditions.

But they are also missing a major opportunity to connect with the part of the population that should be their natural base if they don’t talk about Medicaid.