Is Sadism the Driving Force Behind GOP Rejection of Medicaid Expansion?


Despite a lot of posturing and complaining, the Republican opponents of the Affordable Care Act (ACA) are relatively limited in what they can do to prevent implementation of Obamacare. Sadly, however, there is one aspect of the law that Republicans at the state level have demonstrated that they’re eager to fight back against, and—no big surprise—it’s the one that affects some of the most financially needy Americans: Medicaid expansion. The Supreme Court ruled last year that the provision—which would require states to expand Medicaid to cover people up to 133 percent of the poverty line—is optional, and so far 21 states have decided to opt out.

The result, according to ThinkProgress’ Sy Mukherjee, will be devastating. Mukherjee reports on a new study by the Commonwealth Fund, which shows that these Medicaid expansion refusals could result in up to 42 percent of the people living in those states who went uninsured at some point in the past two years being left out of Obamacare. As the unemployment rate continues to hover above 7 percent, the chance that this giant hole in coverage will somehow resolve itself through employment for the poorest Americans seems like a long-off fantasy.

Make no mistake: The only reason Republican-led states are doing this is out of an ideological distrust often bordering on hatred of the working class. According to the relentless drumbeat of conservative media outlets like Fox News, people who require government help to survive are just lazy leeches who think they’re too good to fight for a better-paying job. But the second that the lowest-income Americans do stand up for themselves and demand better pay so that they don’t have to go on Medicaid and food stamps, the very same conservatives angrily denounce them for that too. You’re a bad person if you need help. You’re a bad person if you seek a job with a living wage. Given the conservative mentality, there’s nothing people can do to win.

The refusal to accept the Medicaid expansion cannot be justified through the usual half-baked conservatives rationalizations. It doesn’t save the states any money to refuse it; the expansion is to be paid for almost entirely by the federal government. In other words, taxpayers in those states will pay the same taxes as everyone else, but their states will get less in return. That means it is costing the states money to refuse the Medicaid expansion. And that’s all before the excessive health costs that end up falling on taxpayers when people who don’t have insurance end up in emergency rooms, often because they couldn’t afford preventive care. In addition, refusing the Medicaid expansion reduces the amount of competition on the insurance market, meaning that even well-off Americans in red states will be paying more for insurance.

In other words, given a choice between saving their states and their taxpayers money and deliberately forcing lower-income Americans to go without health care, most Republican state governments have chosen the latter. (Though not all—Arizona, New Jersey, Iowa, and North Dakota all have Republican governors who decided they want a better-run state more than they want to stick it to the poor.)

Women are going to be badly affected by this petulant screw-the-poor grandstanding on the part of Republican state legislators and governors. This January, the American College of Obstetricians and Gynecologists issued a press release pointing out that 19 million women are uninsured and that the Medicaid expansion could change that. Because of the holes in insurance coverage in the current system, there’s a much higher incidence of bad outcomes with sexual and reproductive health than there should be. Some direct statistics quoted from the press release:

Uninsured pregnant women receive fewer prenatal care services than insured women and are more likely to experience adverse maternal outcomes such as pregnancy-related hypertension and placental abruption. Adverse outcomes, such as low birth weight and infant mortality, also are more common among uninsured women. Improved maternal and fetal outcomes occur with access to high-risk pregnancy care, counseling, and other enabling services. … Inadequately addressing pregnancy complications may have disastrous long-term emotional and economic effects on families. Society may face unintended increased costs to provide medical services to care for children born to uninsured women who have pregnancy complications.

Uninsured women are less likely than insured women to use prescription contraceptives, partly accounting for adverse reproductive health outcomes, including elevated rates of unintended pregnancy and abortion in poor women …

Uninsured women with breast cancer are 30–50% more likely to die from cancer or cancer complications than insured women with breast cancer …

Uninsured women are 60% more likely than insured women to receive a diagnosis of late-stage cervical cancer.

One of the ACA’s great benefits to women of reproductive age is access to birth control without a co-pay. While contraceptive use was already improving in the population writ large—particularly among teens—lower-income women still have serious problems preventing unintended pregnancies, in no small part because paying out-of-pocket for contraception is often out of reach. Pills sometimes have to be skipped because you can’t afford them this month, and while condoms may seem cheap to middle-class Americans, a box of them at the drugstore costs as much as what is supposed to be three days worth of food on food stamps. When you’re living so close to the edge, being able to scrounge up enough for contraception is a touch-and-go thing, which is no doubt why unintended pregnancy rates are going up for lower-income women even as they go down for everyone else.

With one swift, cost-effective move beneficial to both taxpayers and public health alike—embracing the Medicaid expansion—Republican governors can help close the health-care gap between low-income Americans and everyone else, a gap that currently contributes to more unwanted pregnancies and more abortions. They must stop posturing to win the accolades of right-wing media who enjoy the idea of starving out the poor for the simple sadistic pleasure of doing so.

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  • Chris Ranmore

    Yet still the Republicans control these states. This is baffling to an outsider like myself unless the effected demographic doesn’t vote, or the news media is failing to report this honestly.

    • RachelK

      Ever heard of gerrymandering? How about voter suppression? This is the magic formula that keeps states like mine under GOP control. Even with all that going on, the Texas legislature no longer has a GOP supermajority. They lost the supermajority, so now they are going to just redistrict again. What they do is they carve out these oddly shaped districts so that you get the progressive or minority votes all in a small number of districts, then they carve out these other really weird districts to dilute the progressive or minority vote. For example, super-liberal South Austin is in a district that stretches in a narrow band really far south into rural areas of the state, guaranteeing that the voters in Austin are essentially throwing their vote away. The rest of their district is solidly Republican, so it doesn’t matter what they think. Austin is unable to really band together because we are carved up.

      • Jalexmad

        Same in the Congressional district of my former abode, the NC-8. Democrat Kissel beat Republicans Hayes 55-45 and Johnson 53-44 in 2008 and 2010, respectively. This was despite the district being rated as +2 Republican and 2010 being the Tea Party year. The GOP won the entire legislature for the first time since the Civil War in that election. They “redistricted” the 8th so unfairly that in 2012 Kissell lost to the most unqualified likes of Richard Hudson 53-45. That’s a 10 point swing in a Democratic year!!! Last year also saw Republican Governor McCrory elected to make complete the conservative takeover of what looked like an increasingly progressive state just four years ago when Obama won there against McCain. The GOP has since banned gay marriage, cut corporate tax rates, raised the sales tax, eliminated the state income tax (including for the wealthiest people), passed a draconian voter suppression law, opted out of the Medicaid expansion, cut funding for women’s health clinics so drastically that there are only two abortion clinics remaining in the state, and reduced unemployment compensation to a maximum of 20 weeks. So much for the progressive trend.

  • fiona64

    One of the ACA’s great benefits to women of reproductive age is access to birth control without a co-pay. While contraceptive use was already improving in the population writ large—particularly among teens—lower-income women still have serious problems preventing unintended pregnancies, in no small part because paying out-of-pocket for contraception is often out of reach. Pills sometimes have to be skipped because you can’t
    afford them this month, and while condoms may seem cheap to middle-class Americans, a box of them at the drugstore costs as much as what is supposed to be three days worth of food on food stamps.When you’re living so close to the edge, being able to scrounge up
    enough for contraception is a touch-and-go thing, which is no doubt why unintended pregnancy rates are going up for lower-income women even as they go down for everyone else.

    I wish I could tattoo this paragraph on the insides of some peoples’ eyelids. This is a simple truth that far too many privileged people fail to understand. In the anti-choicers’ hurry to close women’s health clinics because “OMGABORTION,” they deny underprivileged women affordable access to the services that help *prevent* unwanted pregnancies.

    • Valde

      Please pass that along to surplusmama.

      The dumb bitch is now parroting abstinence only to me and ‘consent to sex is consent to pregnancy’

      She actually believes that a husband and wife should go 30 years without sex if they really want to avoid pregnancy.

      I can’t fucking believe these nitwits.

    • CT14

      But it’s not really about preventing abortion; it’s about punishing women for having sex. It punishes some men as well, since married women don’t necessarily want more (any) children, but the most fervent anti-choicers refuse to accept any facts about birth control. They either deny it works, call it abortion, or insist it’s a sin and somehow it’s only right and just that their religion is imposed on everyone.

      Try arguing facts with those people. “Wages of sin” is all you’ll get back. Any woman, married or not, raped or not, should be forced to gestate, even a nonviable fetus, and even at the expense of her future fertility, health, and life.

    • AZDem9933

      Much as conservatives hate abortion I believe they hate contraception access even more. If a woman uses birth control consistently and correctly she’s highly unlikely to have an unintended pregnancy and seek an abortion or have an “illegitimate” child. In either case, there’s no way for them to shame her publicly. I think that’s the behind the eagerness to close Planned Parenthood clinics that don’t even do abortions.

    • jruwaldt

      One of the protesters at a clinic where I used to escort told me there’s such a thing as “breakthrough ovulation,” which happens when you take the pill. However, because you’re on the pill, either the zygote doesn’t implant or it gets expelled soon after implantation. She was also convinced that this happens at least once a month, leading to 12-15 “abortions” a year. She was pretty crazy, but this is often what they believe or at least what they claim to believe to justify their opposition to contraception.

  • TexMarine

    Simple solution – move and take these people with you.

    • Jalexmad

      No one should have to move to have their voting power increased. The simple solution is to have a vote for a slate of candidates. If the Republican Party gets 60% of the vote, then 22 of the 36 House members come from the GOP slate and the remaining 14 from the Democratic one. Only in this fashion will the representation of any state be proportional to the will of the people. Besides, is secession your solution to every problem down there?

      • TexMarine

        Who said anything about secession? If liberals are more superior in thought and deed then why don’t liberals rescue these people from these conservative hell holes? Wouldn’t life just be plain better for poor people if liberal caravans helped them move to “better” blue states?

        Oh wait, that’s right; they only preach diversity, but don’t actually practice it (see 2010 Census) and they’re only needed to shore up national elections, especially when they’ve been victimized.

        • expect_resistance

          I’m not a democrat or republican. I’m an ecofeminist anarchist who is sick of the entire political system that kowtows to the corporate state. But the republicans are some mean sick individuals that will deny poor americans help while at the same time they bail out Wall Street and spend millions on corporate welfare. And the Republicans say we are a Christian nation, bullshit. Would Jesus deny anyone medical help if they are poor? The Republicans criminalize being poor and criminalize being homeless. Denying medical care to the poor is evil, it will end lives prematurely — It’s wrong.

    • colleen2

      fuck off

      • TexMarine

        Wow, so eloquent. I see my idea must be a good one, as its brought out the internets greatest thinkers.

        • Jonathan Roth

          “Move and take these people with you.” means the exact same thing as “fuck off”, and is no less offensive just because it doesn’t have the word “fuck” in it.

    • expect_resistance

      No. We will stay and fight!

      Expect resistance!

  • expect_resistance

    Great post. Totally agree. The U.S. has become a neofudalistic corporate state, a banana republic when you’re poor your life expectancy drops or you die. We saw it in the presidential debates when the GOP Tea Party a-holes cheered when someone didn’t have insurance and might die.

    The greedy sick GOP is just that, greedy a-holes who are mean and evil spirited.