The Fight Ahead On Medicaid Expansion

There's two schools of thought on how to approach the notion of red states opting out of Medicaid expansion in the ACA.  The first, championed by wonks like Ezra "Charts" Klein and Kevin Drum, basically says that there's so much in health care industry cost savings (and in new customers for insurance giants) that lobbyists and economic reality will drive states like Texas, Louisiana and Florida to take the money and run.  In other words, economics trumps politics.

But given the Republican Party's behavior over the last four years, I question that.  Not only do I question that, I outright laugh at the notion.  I may not agree with FDL's Marcy Wheeler and David Dayen on Obama, but they are both absolutely right about how the GOP will play the race card on this for as long as it's politically expedient, no matter what the economics say.  Politics trumps economics.  First, Wheeler:

Already, my anecdotal experience is that a proportion of voters in the states in question claim that the first black President has spent his first term making sure that people of color get more than their fair share of benefits (I think they make this argument based on expanded food stamp usage, though of course the argument is not coherent). The GOP frame for the Medicaid argument will not focus at all on insuring the uninsured. It will not breathe a word of how insured people subsidize uninsured people who use emergency rooms for care. Rather, it will extend and enlarge on this argument about a black President giving free stuff to black people (or Latinos in states like Texas). And I believe that will remain true even if Obama loses in November.

Dayen also agrees with this assessment:

But that’s arguing with logic. I don’t know why, given shared history, anyone would believe that logic will rule the day, and red state governors will go against their entire ideological worldview and spend taxpayer dollars – however small – to cover poor people, in many states largely people of color. And if you rely on this numbers game, if you never make a moral argument for WHY poor people shouldn’t have to choose between food or medical care, you have a whole bunch more problems than just this Medicaid expansion.

Democrats, Dayen argues, must now be prepared to go full out and assault GOP governors and say "Here's your death panels, boys. We know that being uninsured leads to people dying earlier, and the Republicans are sentencing millions of the poor to die rather than lift a finger to help just to spite President Obama.  It's the same thing they did with jobs and fixing the economy.  They'd rather score political points than fix anything.  They don't care about saving their states money.  They'd rather kill or drive off all the poor to make them somebody else's problem."

This is where I'm in complete agreement with the FDL guys. Now, the expansion of this logic over at Digby's place inevitably leads to OBAMA FAILED US ON SINGLE PAYER because Medicaid will be seen as unpopular welfare rather than a universal program like SS/Medicare, and I argue that single payer never had a chance here anyway...at least not until next time.

But it has more of a chance than it did before Obama.  Then again, as Yellow Dog points out, the red state that will benefit the most from Obamacare?

Kentucky.  And you better believe Dinosaur Steve will take the money here.