When dogma kills

By Max J. Castro

MIAMI – It seems like the mother of all no-brainers. In a country where tens of millions lack access to medical care, the federal government is offering the states billions of dollars gratis for the next three years to provide coverage to a significant proportion of the uninsured. And, instead of pulling the rug out from under the states when the three years are over, the feds will still cover at least 90 percent of the cost after 2016.

Talk about a proposition you can’t refuse. Except that, unbelievably, lots (although not all) of Republican governors and/or legislatures are doing just that by saying nay to Medicaid expansion under President Obama’s Affordable Care Act.

It’s not as if the people who would benefit from the federal largesse don’t need the help. To be eligible for Medicaid you have to earn no more than 138 percent of the poverty line, or $16,000 a year for an individual and $32,500 for a family of four.

That’s barely enough to put food on the table and a roof over one’s head, never mind paying the exorbitant cost of private health insurance. Moreover, since few of these people work for employers that provide health coverage, without Medicaid they are forced to gamble with their health and their very lives, skipping check-ups and doctor’s visits and going without essential medications for the treatment of chronic diseases. Their last resort, when they are very sick, is the emergency room, where care is extremely expensive for the taxpayer and often too late for the patient.

You can truthfully say that the resistance of many states against Medicaid expansion, despite no or minimal cost to them, is insane, mean, cruel, callous, even criminal. But you can’t say it is popular, even in the heartland of right-wing America. A recent poll of five of the most conservative states in the country – Alabama, Georgia, Louisiana, Mississippi, and South Carolina – whose governors and legislators are eschewing money for Medicaid expansion found that 62 percent of the people disagree with their alleged representatives.

It is little wonder. Four of these states rank among the five worst in the nation in terms of the general health of their population and the other (Georgia) ranks 36th. Millions of people in these states desperately need what Medicaid expansion would provide. The politicians have shown they couldn’t care less.     

The most remarkable thing is that for once Republicans are not waging class war on the poor and near-poor mainly on behalf of the usual suspects – lobbyists, Wall Street, huge corporations, the very rich. This time it is almost purely an expression of an extremist, Manichean ideology which holds that anything that the government does is bad by definition.

What is a right-wing ideologue to do when the federal government, in other words the Devil, offers on a silver platter a huge gift that even the citizenry in the most benighted states in the nation overwhelmingly understand is a good thing?

The varied, nonsensical excuses offered by the opponents of Medicaid expansion, and the bitter division within the GOP itself over the issue, reflect the right-wing’s ideologue’s dilemma. To oppose Medicaid expansion on the terms offered by Obama is very hard to justify. Refusal makes so little sense to most voters that previously recalcitrant politicians coming up for reelection, like Florida Gov. Rick Scott, have found it prudent to change sides and support Medicaid expansion. But the Republican-controlled Florida legislature, like those in many other states, killed it anyway.

On the other hand, allowing Medicaid expansion, precisely because it is a good thing made possible by the federal government that will significantly help countless people, undercuts the ideological foundation on which today’s reactionary Republican Party was built. That foundation was best encapsulated by Ronald Reagan: “Government is not the solution. Government is the problem.”

Yet the reality is that, for the problem Medicaid expansion responds to, government is the only solution. Certainly, the “private sector” hasn’t produced any solution for the millions of near-poor, many with jobs and families, that can’t afford what the health insurance industry sells. And the alternatives to Medicaid expansion proposed by a few Republican lawmakers, including one in the Florida legislature, are beyond pathetic.

The campaign against Medicaid expansion reveals, perhaps better than anything else, a very cold truth about a very large sector of the modern Republican Party, namely that it will go to almost any lengths, including playing with people’s lives and health, to safeguard its defining ideological dogma.