We all know this.
But it is highlighted by the work of the very sharp Carter Price and David Evans, who have the infographic of the month:
…access to expanded Medicaid… and how a ruling by the Supreme Court in… King vs. Burwell… would affect ACA coverage…
From the perspective of any individual state, both the Medicaid expansion funds and the health-exchange subsidy funs are free money:
The first provides federal reimbursement for new Medicaid enrollees’ covered health-care services, and reduces state-level funding burdens to the extent that state-level programs are superseded by Medicaid expansion (and every state has some such). Roughly half of the direct money flow shows up as better access to health care for the non-working poor and the working poor of states that expand Medicaid. The other half of the direct money flow shows up as hospitals, doctors, and nurses getting paid for things they currently do for free. And all of the direct flow shows up as higher incomes for those working for the health-care sector. And then there are the indirect flows: in the long run after migration of businesses, capital, and labor is completed, one extra dollar in federal money coming into a region leads to a six-dollar boost to regional economic product.
The second do the same–only for the working classes: both those who were not able to afford insurance in the malfunctioning pre-exchange small-group market, and those of the working classes who did somehow scrape up the money for insurance at the cost of great financial pressure on their budgets. Significant improvement in the health access and financial status of beneficiaries. Better income statements and balance sheets for hospitals, doctors, and nurses. And, of course, the same six-to-one long-run regional economic product multiplier.
The infographics are great–the only thing I would wish for would be for a third dimension for population density, or perhaps tracking population numbers rather than population percentages (but percentages are useful):
When we look at the Medicaid expansion map, we see graphically–literally graphically–the extraordinary unconcern of the Red State political establishments for the health and financial stability of their non-working poor and working poor, and for the financial prosperity of their health-care sectors. If you were a die-hard nullificationist in 2011 you might have argued that a Republican victory in 2012 would overturn the game board and that a Red State should not look itself into ObamaCare. But ObamaCare will be at most tweaked in 2017. And the states that failed to expand are now throwing away enough free money to make a difference on the statewide economic level between rapid and sluggish economic growth.
The only way I can find to understand the pattern of Medicaid expansion nullification is a truly extraordinary unconcern on the part of Red State politicians with their poor–whether working or non-working–and substantial insulation as a result of the rise of right-wing billionaires from financial pressures put on them by the doctors who used to be the financial fund-raising bedrock base of the Republican Party. Plus remarkable unconcern with the the health of their state-level economies. But even if they do not care about the well-being of their citizens, they should care about competing for the votes of the non-working and the working poor, shouldn’t they? Or do they just think that the poor are low-information voters, and that those who pull the lever for the Republicans will not be unhornswoggled by looking across the Missouri-Illinois or the Tennessee-Kentucky or the Mississippi-Arkansas or the Texas-New Mexico state line and thinking: “Hmmmm…”
The ineffectiveness of the voice of the doctors I just do not understand. It goes against all theories of rational-choice political economy, it does.
The picture of those at risk from a sadistic nullification opinion by John Roberts in King v. Burwell looks remarkably similar. Idaho and Nevada somehow established state-rune exchanges without expanding Medicaid, and so their working classes are insulated. And the working classes of Pennsylvania, Ohio, and Indiana are added to those at risk, as are those of Nebraska, North Dakota, and Wyoming.
Once again, the lack of power of the health lobby to move the Red-State Republican political establishments is astonishing. The lack of any sense on the part of the Red-State Republican political establishment that they are there to work for or in any sense represent the working classes of their states is astonishing