On July 9, 2012, just two weeks after a divided Supreme Court upheld the constitutionality of President Obama's Affordable Care Act (ACA), Texas Governor Rick Perry decided to make a stand for liberty.
The governor was disappointed with the ACA decision. If it had been up to him, the whole thing would've been ruled unconstitutional. But his options for resistance were limited. Perry could do nothing to stop the creation of state health insurance exchanges; if he refused, the federal government would simply create one for his state. He couldn't hold off the individual mandate either – like citizens of the other 49 states, Texans would be assessed a fee, newly rationalized as a tax, if they failed to procure health insurance and didn't qualify for an exemption under the law. He couldn't even protect businesses from the crushing (albeit easily, if cynically, circumventable) obligation to provide basic insurance for full-time employees.
In these ways, it seemed, the people of the Lone Star State would never again be free. But in this dark hour, Governor Perry saw a sliver of light that, along with other Republican governors, would allow for one of the worst, underreported tragedies of the last decade to occur.
He saw his opening and took it. A vital provision of the original health care reform law mandated that states accept federal funding to expand Medicaid eligibility for any adult with an income under 133% (now 138%) of the federal poverty line. The requirement was there to make sure that the poorest Americans, some 17 million who could not afford insurance even with new subsidies, would still be covered in some form. But, according to the Supreme Court, the federal government couldn't require states to accept the cash or implement the expansion. If a Governor felt like denying health care coverage to the poorest among their constituents on principle, that was their call. Rick Perry decided to make it.
"I oppose both the expansion of Medicaid ... and the creation of a so-called 'state' health exchange," he told Secretary of Health and Human Services Kathleen Sibelius in a letter, because the programs represented "brazen intrusions into the sovereignty of [Texas]."
"I stand proudly with the growing chorus of governors who reject the Obamacare power grab," he said, going on to call the Affordable Care Act "Orwellian."
And so, in the name of the Founders, Rick Perry denied health insurance to an estimated 1.3 million Texans who would have qualified under the proposed expansion.
He wasn't alone. As of last month, only 25 states and the District of Columbia have voluntarily expanded their Medicaid programs. The unlucky impoverished of the remaining 25, under the resolute leadership of men like Florida's convicted Medicare fraudster-come-Governor Rick Scott, have become part of a growing "Medicare eligibility gap": an estimated five Americans who remain uninsured despite a federal government willing and able to foot the bill. No doubt they feel especially free right now.
Image credit: The Advisory Board Company
With attention focused on the enrollment rate for healthcare.gov, the state-by-state implementation of a poverty eligibility adjustment impacting less than 10% of Americans hasn't gotten a ton of coverage. It's a slightly wonky issue, and, with its calculations and contingencies, doesn't lend itself to easy explanation. And so the (exclusively Republican) governors refusing to comply have gotten away with little political consequence. When they haven't benefited from lack of interest in the issue, they've fought: Right now, the Louisiana GOP is suing MoveOn.org over the progressive site' refusal to take down a billboard calling attention to the 242,000 Louisianans saved from federal tyranny by Governor Jindal.
We need a new strategy for calling attention to this issue, and for driving web traffic to our cause. If clicks are caring, then by the much-bemoaned state of journalism, those clicks must be bated. So let's try something more appropriate to the age of the sensational. According to a Harvard study, as many as 17,000 Americans will die as a direct result of not becoming eligible for Medicaid in their state. That's on top of the 45,000 annual dead from a general lack of insurance.
Or, in other words, the Medicare eligibility gap will murder at least five times as many people as 9/11.
Is it fair to compare the denial of health insurance to a nation-shaking terrorist attack? In the important ways, yes. Twenty-twenty hindsight and bin Laden-determined-to-strike foresight aside, nobody exactly allowed 9/11 to happen. There was plenty of finger-pointing after the fact, but at no point did somebody put a bill on President Bush's desk and tell him if he didn't sign it, there was going to be a body count. And if the Patriot Act taught us anything, it's that President Bush — love him or hate him — wouldn't have declined to sign such a bill, had it existed, in the name of "liberty".
So imagine the public backlash if it had turned out there were studies years in advance of Sept. 11 detailing exactly what would happen on that day. Imagine if they included estimated casualty counts and demographic predictions of who the dead would be. Imagine if the attacks happened despite the fact that elected leaders could have prevented them by simply accepting federal money. Now imagine that happened five times.
9/11 may have been a consequence of negligence, but the governors refusing to sign on to the Medicaid expansion are guilty of criminally negligent homicide. When the dead start piling up, nobody will even go on TV and swear to avenge them with bombs.
Republicans claim that their refusal comes from a place of fiscal responsibility. Don't believe them. Under the plan, the federal government — which is more than able to afford the relatively modest program — would foot 100% of the bill through 2020. After that, they'd foot 90%. In states refusing the expansion, overall medical spending will actually increase. There's no rational basis for refusal, only an all-too-familiar willingness to defy the president out of blinding spite.
These Republican governors (with some surprising and admirable exceptions like Arizona's Jan Brewer) are sitting idly by and allowing Americans to die, which leads us to an even better way to calculate the human cost of the Medicare eligibility gap, one that might be especially appealing to our friends in the GOP.
You think 9/11 fives times over is bad? The predicted 17,000 American dead also equals a sum total of 4,250 Benghazis. And these citizens didn't even sign up to go to a war zone.
No doubt Darrell Issa will be on the case soon, and refuse to ever, ever let it go, just as soon as he's finished embarrassing himself with the IRS.