The War on Medicaid Expansion Exposes the Nihilism of the GOP – The New Republic

Last August, Missouri voters made themselves perfectly clear when they voted to expand the states Medicaid program, passing a ballot measure with 53 percent of the vote. It was just the latest in a series of recent victorious expansion campaigns in red-leaning states, including Maine, Oklahoma, Idaho, and Utah, aimed at plugging a gaping hole in the Affordable Care Act created by the Supreme Court. While the high courts 54 ruling in National Federation of Independent Business v. Sebelius was, in 2012, hailed as a victory for upholding the legality of the individual mandate, there was less attention paid to what turned out to be a far more consequential caveat: that the choice of whether to extend Medicaid eligibility to cover all residents below 138 percent of the federal poverty line would be left to individual states. Several Republican-run states used their newfound leverage to win concessions from the federal government, such as lifetime benefit caps or monthly premiums that were never supposed to be part of a public safety net program intended for vulnerable patients. Many other states under GOP control took a more destructive path, refusing to change their Medicaid eligibility requirements at all and stranding some four million people without insurance; this included more than 200,000 Missourians.

Ironically, nearly a decade after the Sebelius ruling, we have come to understand that the individual mandate barely mattered at all to the law, and that Medicaid expansion accounted for far greater gains in insurance rates than tinkering with the individual market produced. We also have years worth of research on the tremendous impact Medicaid has on patients lives: Enrollees were able to access and use more necessary care; their health outcomes improved; and they experienced greater financial, professional, food, and housing security. This smorgasbord of quality-of-life gains was remarkable enough to win over large margins of the countrys most ostensibly conservative voters.

In Missouri, that may not be enough. The state Senate has voted 20 to 14 against funding the winning measure, effectively punting the issue to the courts to determine whether a cut-and-dry referendum ought to be acknowledged. Youd be hard-pressed to find a purer distillation of the Republican Partys nihilistic political project anywhere in the country.

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The War on Medicaid Expansion Exposes the Nihilism of the GOP - The New Republic