How Republicans are sabotaging the ACA, hurting the poor, and driving up costs for the middle class; by @DavidOAtkins

How Republicans are sabotaging the ACA, hurting the poor, and driving up costs for the middle class

by David Atkins

Joshua Holland at Moyers and Company has a great piece on how Republicans are driving up ACA costs across the board through their insistence that the poor get sick and die quickly:

The media have been buzzing with stories — many of them wildly exaggerated — of people facing higher premiums as a result of Obamacare. But there’s a story about rates you may not have heard: According to Jonathan Gruber, a leading health care wonk at MIT, all private insurance premiums in the 25 red states that are refusing to expand their Medicaid programs will be 15 percent higher as a direct result of that decision.

But those numbers don’t capture the human cost. The reality is that conservatives are complaining about insurance policies being cancelled and the ACA’s error-plagued exchanges at the same time as they actively work to keep millions of poor Americans from gaining coverage under the law’s Medicaid expansion.

The victims of Obamacare’s implementation problems being hit the hardest, by far, are those whose incomes fall between the federal poverty line and the eligibility cutoffs in those 25 states rejecting Medicaid expansion. Not only will they be left uncovered, they won’t even be eligible for the generous subsidies that people earning slightly more than they do can use to buy insurance. It’s brutally unfair. The Kaiser Family Foundation estimates that 4.8 million poor adults may fall into that coverage gap — about twice the number of people expected to pay more for their insurance when their substandard policies are cancelled.

And it gets worse. In 40 states, adults without children are ineligible for Medicaid regardless of their income level. In 30 states, the parents of children who qualify for Medicaid may not be eligible themselves. All of these people would be covered under Medicaid’s expansion, but they’re being left high and dry in the 25 states who have rejected expansion. And while the problems plaguing result from mismanagement and a contracting boondoggle, those red state lawmakers who refuse to expand Medicaid are inflicting this harm intentionally, based solely on their ideology.

In other words, they’re actively working to maintain America’s shamefully high rate of uninsured. And that comes with deadly consequences. Because, in this country, we do ‘let ‘em die’ – we let the poor and the uninsured die from treatable illnesses every day.
The level of cruelty and spite at work here is flabbergasting. It's one thing in politics to hurt one constituency to benefit another. That's not unusual, though the best public policy tries to achieve mutual wins for everyone.

But there's literally no one who is helped by Republican actions. The poor, both white and non-white, are hurt by the failure to expand Medicaid. The middle class are hurt by higher premiums. The rich don't see any direct benefit. Insurers stand to lose if fewer people buy into the exchanges. Republican politicians don't even necessarily benefit either in primaries or in general elections: Medicaid expansion isn't generally seen as a litmus test issue in Republican primaries, while the entire issue of Obamacare repeal is an unpopular net drag on Republicans in the general electorate.

This is simply spite, cruelty and take-no-prisoners social darwinism writ large. It's sociopathy codified into public policy. And it's mainstream Republican lawmaking in 2013.