Harold Pollack at Same Facts has a great map that shows where making Medicaid expansion optional is hurting people.
We know the upper Mountain West is looking for ways to tweak and twist their Medicaid programs to align with both conservative policy goals and liberal coverage expansion. We know Maine has an asshole for a governor but a non-veto proof majority in the Legislature that is pushing for Expansion. We know Virginia has a split political elite that is slightly tilted against expansion. But the Deep South is where there is a wide spread elite political consensus that it is best for their political leaders to stand in the hospital doors to prevent poor people from getting healthcare. Arkansas is looking to regress from its expensive and convoluted but successful private option implementation to either nothing or far less for its poor citizens.
This was predictable, reactionary states that run on extraction economies and have a political history of nullification would nullify laws that threaten elite privilege however they could. And the Roberts Court narrowly but consistently is providing a set of tools for nullification to work.
- Don’t like black people voting, well the sovereign dignity of the states is offended for the usual repeat offenders from being supervised despite there being a bail-out provision for good behavior.
- Don’t like poor people people living productive lives and not genuflecting to their betters — well Medicaid expansion is optional as the deal is coercive and insulting to the dignity of the states.
- Don’t like middle class people getting help to live productive and healthy lives while not genuflecting to their betters — well of course the language in the law authorizing subsidies is so clear that the CBO never even had to model what would happen if a state elected not to establish an exchange.
GregB
If they have any dying to do, let them do it now and decrease the surplus population.
-Ebenezer Scrooge
Marmot
Here in Texas, we need people to simply vote, particularly from the lower economic classes and minorities. That alone would turn this travesty around.
Ignored by the Dems so long, though, we have no GOTV infrastructure to speak of, and no enthusiasm for or knowledge of Dem contenders. Sigh.
C.V. Danes
If Kansas is a guide, then stupidity has a distinct majority that can be hard to overcome. I would suggest that southerners might want to stop voting for the party committed to robbing them, but, you know, Kansas.
RSA
Nitpick: Actually not. We recognize states, I think, by their location and shape, both of which are distorted here. State abbreviations for labels would help.
Elizabelle
Send this map to John Roberts.
He did this.
Elizabelle
@RSA:
Agreed. It’s not that great a visual.
Richard Mayhew
@Elizabelle: It is a map weighed by population that is in the Medicaid gap. It makes states like California and New York (big states with Medicaid Expansion) far smaller. For the story that Harold was telling, it is a great graphic.
WereBear
That’s the question that never gets asked, isn’t it? The subtext of Let the states do what they want is Why would a state act that way?
It’s no wonder I have a reflexive hot-stove-reaction when a politician says States Rights. Because they are really saying “Die and enrich me!”
Elizabelle
@Richard Mayhew: It kinda looks like the South mooning us.
Elizabelle
From Harold Pollack’s article:
Belafon
The Robert’s court is giving us a history lesson: If you ever wondered how frustrating it was for Roosevelt to deal with Supreme Court shooting down legislation becase reasons, here you go.
And the only thing that really fixed that was WWII, because Southern Democrats turned against him at one point.
PIGL
@Elizabelle: he wanted to, and has no plans to stop there.
schrodinger's cat
Is this not what the Republicans want? It is government of the 1% for the 1%. I don’t when the 99% who vote for them will realize that their elected representatives hold no particular allegiance to them.
PIGL
@WereBear: and the ahem white people doing much of the dying vote for it with great enthusiasm and in-apparently-overwhelming numbers. I wonder why?
Jado
@C.V. Danes:
It will never happen, as long as the Barons rob the Blahs and the Gheys a little more than the poor rubes.
If you get your wallet stolen every Friday night and there’s nothing you can do about it (except vote Democrat *shudder*), than at least take comfort from watching the black guy next to you get his wallet stolen AND have his nose broken. And the gay guy can get sent to the hospital with multiple internal injuries.
That’ll teach those filthy mudbloods to try to compete with the purebreds. Thank god for the Barons to keep this hierarchy straight.
Bobby B
It kind of looks like a fat southern fuck having a heart attack from Chick Fil A grease and Denny’s breakfast bars. Not that I’m prejudiced.
WereBear
@PIGL: You ever watch Justified?
I have a bit of an episode limit, because I went to high school in a small Southern town. So I have a very low threshold when it comes to mean-eyed, rock-ignorant, tantrum-throwing, miserable human beings whose only response to adversity is to make sure someone else gets more.
OzarkHillbilly
@Richard Mayhew: Richard, I wish you would stop beating around the bush and just tell us how you really feel.
Tripod
@Belafon:
I see some leftists mindlessly blathering that the Democrats should just placate the FU boys and make it the way it was, as if this is self evident and easy to implement with some populist blather. The issues go way back, and the only acceptable solutions for these southron idiots to come back into the fold would be un-democratic, and against all human decency.
Sean
Michigan approved the Medicaid expansion so it looks like this map is drawing from an old data set.
PIGL
@WereBear: I’ve watched Seasons 1 and 2, and enjoyed them quite a lot. Have the rest cued up. Would not exactly want to live in that world, though I do like have an affinity for the music.
Tripod
I would also point out to the chief racist of the supreme court that Monday was still a holiday in Arizona.
Cervantes
@RSA:
What you think of as distortion is part of the point. Looking at state outlines alone does not immediately show how many people are being hurt.
Labels, though, might help, I agree.
WereBear
@PIGL: Oh, it’s an absolutely awesome series, so well done. And, sadly accurate.
But I fled the south as soon as I could because it’s a truly awful place for anyone who doesn’t fit into the mold they want to hand you. And you only get one.
Sherparick
Driftglass goes the full Shrill today on the Republican Death Cult (which has a legislative lock on the United States and the Supreme Court). It must be read. re http://driftglass.blogspot.com/2015/01/if-reagan-is-not-risen.html
Svensker
We have a cousin in Georgia who’s a nurse and, of course, a tea partier. One of the hospitals in her town is probably going to close because Georgia declined Obamacare and is losing lots of money in the new paradigm. She, of course, doesn’t blame Georgia’s lunatics, such as herself. She blames Obama and Obamacare. She had the nerve to say how awful Ocare was to someone who had just endured a double mastectomy and reconstructive surgery that was paid for through insurance only affordable thanks to Obamacare.
They really don’t get it.
Davis X. Machina
@Jado: Precisely.
Too many people, when confronted with the deal “We won’t actually make your life better, but we’ll make someone else’s life worse, and let you watch. Is that going to be good enough?”, say “Sure.”
Marmot
@PIGL: I can’t speak for the other bloated states on this map, but in Texas, voter turnout is terrible. What you see is the result of the preferences of older, more conservative people, who do vote.
Richard Mayhew
@Sean: Good point, I will e-mail Harold with that.
PDiddie
@Elizabelle: So that would make Arkansas the anus of the nation?
Pogonip
@PDiddie: No, that would be eastern Kentucky. It was 3rd-worldish in the ’70’s. I hate to think what it’s like now.
C.V. Danes
@Jado: Yup. Seems like people are starting to wise up and move out of the state, though (Kansas, that is).
VFX Lurker
@Sean:
It threw me off, too, until I realized that orange “Michigan” wasn’t actually my home state of Michigan — it was a bloated Wisconsin and Indiana bordered by Medicaid expansion states. “Lake Michigan” is Iowa and Illinois. “Lake Superior” and “Lake Huron” are formed by Michigan and Ohio. “Lake Erie” and “Lake Ontario” are made up of Northeastern states.
These medium-blue states represent states on the federal exchange that expanded Medicaid but rely on a federal health insurance exchange, and the blue color makes them look like the Great Lakes.
Proof: the dark-blue state under the “Lower Peninsula” of “Michigan” is Kentucky. ;-)
RSA
@Cervantes:
Sure. Maybe I should have said more. (I work professionally with visualization researchers.) Notice that Harold is “dual coding” the Medicaid gap states by color and by size in the second map (a cartogram). He could have visually encoded more information in his first map (a choropleth map) by, say, using the luminance or saturation of a color to represent the number of people affected. And then we wouldn’t have people confusing Michigan with Wisconsin and states with lakes, as VFX Lurker points out.
JR in WV
I spent a year in Mobile, AL and Pascagoula, MS back in 1971-72; it was terrible. Pascagoula was a sleepy little fishing town when Ingalls-Litton bought the local shipyard and won the bid for lots of work for the USN.
The population jumped from 8,000 to 20,000, with no parallel increase in infrastructure. One liquor store with a sign that said “All Proceeds from Sales to Ni**ers will be donated to the United Klans of Amerika”. The whole town was like this.
The Civil Rights Act was passed, and ignored. The opression was on full warp. I got discharged in Feb and we left instantly for W Va, where it was 15 degrees.
Hal
A conservative Facebook friend is currently claiming that prior to the 1960s healthcare was much cheaper and people would simply work out affordable payments with their doctors. Now that big insurance is involved, costs are sky high. I wasn’t aware that the 50s were some cheap utopia were everyone (according to him) just bought their own policies and lived happily ever after. Of course, this is also someone who keeps warning everyone that they aren’t getting refunds this year because of the mandate penalty too. I’m finding it less and less surprising that some people dont think health insurance is a necessity, especially when they already have insurance.
Elizabelle
@Svensker: What an awful cousin.
Try not to think about her as you successfully recover. Glad Obamacare was there for you.
Hope karma smacks that heartless nurse upside the head but good.
RSA
@Hal: Politifact has an interesting take on a variation of this claim from Ron Paul.
VFX Lurker
@Hal:
Ask him if he really, truly wants his cancer, heart attack or liver transplant handled by medical techniques and equipment that was state-of-the-art in the 50’s.
Modern medicine may be more expensive, but it also does more, too.
rikyrah
My Dear Richard..
this is the POINT with them.
And NOBODY will convince me that it isn’t directly related to the levels of Black people that would be helped if true Medicaid explansion were to happen.
Mnemosyne (iPhone)
@Hal:
So if he or a family member is diagnosed with cancer, he’s going to reject that newfangled chemotherapy and radiation treatment? Those weren’t invented until the late 1950s. Until then, a cancer diagnosis was a flat-out death sentence. He really wants to return to that in order to save a little money?
Cervantes
@JR in WV:
Ingalls-Litton had been operating there for a while, building subs — Skipjack-class and Thresher-class, mostly.
john fremont
@Hal: Funny ,I remember cartoons in the comic strips and in old Mad magazine about people getting their doctor bills and falling over in shock or some such reaction. I recall the same sort of thing in Reader’s Digest when I was growing up in the early 1970’s on their jokes pages like Life in These United States.
Jack the Second
While you’ve got to assume that anything correlated with the South has a racial component, I think this is connected to the other big idea, that economics == morality. Rich people are good, and deserve good things; poor people are bad, and deserve bad things. The divine right of billionaires, if you will.
Obamacare — and Medicaid and Welfare in general — upset this natural order by bringing good things to poor people, who are bad and deserve bad things.
Some mouthpieces may talk out their ass about how Obamacare doesn’t work or is expensive or upsets the delicate fee-fees of abstract States, but ultimately the problem is that it successfully accomplishes a goal they find abhorrent.
EthylEster
@WereBear:
Me, too.
And I rejoice in that decision every time I fly into Orlando/Tampa (to visit aging parents) and am offended by some asshole’s racist speech before I get out of the fucking airport terminal.
Older
@Hal: I was an adult with children by the end of the 50’s so I experienced that system and all subsequent systems personally. Two important things have happened to medicine since the 1950’s.
First, as VFX Lurker and Mnemosyne said, there has been a lot of new and wonderful medicine invented or discovered since then, and a lot of it is expensive.
Second, the insurance industry has taken over the business of medical payments, which has had the effect of transferring a lot of the money we think we are paying out doctors to the pockets of CEO’s of insurance companies (and to a lesser extent to the pockets of the large staffs employed by both insurance companies and doctors offices to argue with each other). Without this change, a lot of doctors would be able to get along, and in effect do get along, on payments of about the same size as we made back then. I have met several doctors who refuse to deal with insurance companies, and whose fees for office calls have gone up gradually over the past forty or so years that I have known about them, but are still well under $100. But I think most of them are old enough to retire now, so that will be the end of the contrary evidence, such as it is.
EthylEster
@JR in WV wrote:
Funny thing..it’s still 1971-72 there.
EthylEster
@Hal wrote:
One this is FOR SURE: docs don’t want to go back to that time. They make a lot more money now. Medicare made them rich.
Sean
@VFX Lurker: Good call, definitely fooled my lyin’ eyes.