The Right’s Adherence to Limited Government Imperils Medicaid Expansion

by Jeremy Leaming

It is hardly surprising that a string of right-wing governors are declaring that it will not cooperate with a major portion of the Obama administration’s health care law aimed at expanding Medicaid to cover millions more of the uninsured.

For decades the Republican Party has become obsessed with advancing the interests of a very small, but powerful group of individuals – the one 1 percent who control the vast majority of the nation’s wealth. In a piece last year for Vanity Fair, Columbia University Business School Professor Joseph Stiglitz argued that the nation’s super wealthy are out-of-touch with the rest of the nation, and does its best to ensure that separation.

“The rich don’t need to rely on government for parks or education or medical care or personal security – they can buy all these things themselves. In the process they become more distant from ordinary people, losing whatever empathy they may once have had. They also worry about strong government – one that could use its power to adjust the balance, take some of their wealth, and invest it for the common good. The top 1 percent may complain about the kind of government we have in America, but in truth they like it just fine: too gridlocked to re-distribute, too divided to do anything but lower taxes,” Stiglitz wrote.  

The Affordable Care Act, however, does include measures aimed at investing in the common good. The Medicaid expansion for instance calls for the states to greatly expand their coverage to all people under the age of 65 with incomes 133 percent of the federal poverty line.

This was always a part of the discussion overhaul health care – to extend affordable coverage to the tens of millions of uninsured. The New York Times reported this weekend that millions of “poor people could still be left without medical insurance under the national health care law if states take an option granted by the Supreme Court and decide not to expand their Medicaid programs ….”

In upholding the ACA, Chief Justice John Roberts said the Medicaid expansion was a permissible use of Congress’s spending power, but was limited. Roberts claimed that court precedent had set the limits and in this case it meant that the federal government could not mandate that the states expand Medicaid.

Roberts noted that the ACA “provides that the federal government will pay 100 percent through 2016. In the following year, the federal payment level gradually decreases, to a minimum of 90 percent.” If the states refused to expand their Medicaid programs, the federal government could end current payment to the states. But the chief justice joined by a majority of the justices concluded that was abuse of Congress’s spending power.

The Court therefore said states could refuse to participate in the Medicaid expansion without being penalized. The states could opt out of the health care law’s Medicaid expansion, thereby leaving tens of millions without access to affordable health care.

And as TPM, The Times and others are reporting, Republican governors of S.C., Florida, Louisiana, Missouri, Wisconsin, Kansas, are claiming they will not participate or are threatening to block extended coverage.

Salon’s Steve Kornacki writes that logic “says that most, if not all,” the governors will come around.” Because this is more political posturing than anything, he says. Yet, he also acknowledges the power of the “Tea Party-era Republican politician,” which despises any form of progressive policy, and is dedicated to a seriously restricted government, one that can only embrace tax cuts for the super wealthy.

Constitutional law expert Pamela S. Karlan in an op-ed for The New York Times said the ruling on Medicaid is one that should seriously concern liberals.

“For the first time since the New Deal, the court struck down an exercise of Congress’s spending power,” she wrote. The majority held, she continued, “that while the government can deny additional Medicaid funds to states that refuse to expand their coverage, it cannot penalize them by rescinding current Medicaid payments.”

Karlan, a law professor at Stanford and an ACS Board Member concluded that, “A Congress that can advance national priorities only through its taxing power is a Congress with little power at all.”

And there is the win for the nation’s right-wing, which continues to rack up victories for the super wealthy at the cost of everyone else.