Clearly, it’s gratifying to see that, after all of our hard work, the Supreme Court didn’t throw out the entire Affordable Care Act. But as we noted, one part of the decision held some cause for concern: the Court weakened the requirement that states expand Medicaid coverage, using federal funding, so that millions of people at or near the poverty line could get health care.
The Court ruled, narrowly, that states could opt out of providing the additional Medicaid eligibility, which would leave a substantial gap in the number of people with coverage. Since the federal government would be providing all of the funding for this expansion for the first few years and 90% of it going forward, however, there would be little reason to decline the expansion of Medicaid, outside of a combination of ideological extremism, disinterest in covering the most vulnerable people and pure spite over the passage of the ACA.
Well, we’ve learned to never underestimate that combination. Gov. Rick Scott of Florida announced Sunday he would turn down federal funding and block the Medicaid expansion.
A study by the Urban Institute suggests that in Florida alone, 1.8 million people would be eligible for the expanded Medicaid coverage—and, because of Scott’s stubbornness, nearly a million and a half of those people would be left uninsured, with exactly the same bad set of options they have today.
The rejection of the Medicaid expansion has been the biggest danger underlying Thursday’s ruling. Medicaid expansion was supposed to cover everyone with incomes below 133% of the federal poverty level. It’s really the only option available for those under the poverty level, which is just over $11,000 for a single person and just over $23,000 for a family of four. Without the expansion, people at this level of income (and that includes millions of minimum-wage earners and people who work part-time) are very nearly out of luck.
Other governors who have suggested they might not take the Medicaid expansion include Louisiana Gov. Bobby Jindal and—surprise!—the ever-frustrating Gov. Scott Walker of Wisconsin. The biggest question mark here is Texas, a huge state with a big uninsured population and a governor given to loud displays of ideological purity.
In Virginia, Gov. Bob McDonnell is faced with the same choice; while he’s spoken publicly about repealing the ACA, his state is implementing the law, and health care experts there call denying the expansion “catastrophic” and “foolish.”
David Dayen of Firedoglake has offered some very good analysis of the stakes of this Medicaid fight, and why these governors might make a show of refusing. Other analysts have suggested that, since the Medicaid expansion is a good deal for states, they’ll end up taking it eventually—but it will take time and pressure to get us there.
As Salon’s Steve Kornacki notes, this is mostly about politics for governors like Scott.
Essentially, the court handed Republican politicians a high-profile opportunity to define themselves in opposition to President Obama’s signature accomplishment, a law for which their party’s has particular contempt. So there’s an element of posturing here…as long as Obama is president and his name is linked to it, there’s always going to be some kind of an opening for a Republican politician to make a name for himself by vowing to stop or reverse the expansion.
As a game played among boldfaced names in political reporting, this is bad enough. But it’s much worse when you consider that the playing pieces in Rick Scott’s little chess game are people trying to feed their families on $20,000 a year.
This is the next fight for health care—to make sure that our elected leaders are doing their job and actually implementing this bill. This is an opportunity to put pressure on our representatives in state capitols. Politicians like Rick Scott can’t be allowed to let their spite and their ideological obsessions prevent millions of people from the promise of health care.