In my post on the health care law ruling yesterday I mentioned I would save for another day what I meant by this:
judging by this decision, I see only two consistent “liberals” on this court, Ginsburg and Sotomayor.
What I meant was their just refusal to join the other seven justices—including the usually sensible Steven Breyer and the ideologically suspect Obama appointee, Elena Kagan*—in ruling unconstitutional (it’s complicated, so see here) any attempt by the feds to terminate existing Medicaid money to states (almost all Republican-controlled states, of course) who might refuse to go along with the ACA’s expansion of Medicaid, an expansion that would enable millions of needy folks to get health insurance.
But, as usual, the needy just don’t have quite enough friends in powerful places.
For those who don’t know, Medicaid, created along with Medicare in 1965, is a federal-state effort designed to provide medical and health benefits to poorer folks, including children, who would otherwise go without all but emergency health care at hospitals. It is funded by both state and federal sources, the funding formula based on per capita income in the various states, with no state going without at least 50% federal funding (the average the feds pay is 57 percent).
The ability to withdraw all Medicaid funding, not just that associated with the expansion, was seen as a big stick in getting reluctant (red) states to do the right thing. And the Supreme Court—again, including two justices appointed by Democrats—held that the federal government cannot coerce states or penalize them in such a manner, even if it is to do the right thing. Paul Clement, who argued the case for the bad guys, characterized this part of the decision as “really quite significant.”
Yes, it is. Here’s how USA Today summarized it:
The court struck down a portion of the law that would have forced states to accept a major expansion of Medicaid to all Americans earning up to $30,733 for a family of four or risk losing all federal funds under the program.
Roberts called that part of the Affordable Care Act “a gun to the head” by threatening as much as 10% of states’ budgets.
By removing the “gun to the head,” the Court has made it voluntary for the states to provide expanded health insurance for its neediest citizens, to folks with incomes at 133 percent of the national poverty line.
And even though the federal government is picking up nearly all of the tab for the expansion, inevitably there will be Republican opposition, since that political party is long on hatred for Obama and short on love for the neediest among us.
Don’t believe me? How about this headline and story from the AP:
Top Mo. Republicans oppose Medicaid expansion
JEFFERSON CITY, Mo. (AP) – Top Missouri Republicans say they have no intention of expanding Medicaid eligibility as a result of the Supreme Court’s ruling on the federal health care law.
The story relates that Missouri House Majority Leader Tim Jones will not consider the expansion, and the stripper-lovin’ Lt. Gov. Peter Kinder falsely called it a “break-the-bank provision.” Obviously, these unkind gentlemen don’t give a damn about the Missourians who would be helped, including doctors who treat patients who can’t pay, nor do they appear to give a damn about Missouri hospitals, most of whom have to absorb themselves or pass on to others the cost of uninsured patients they are required by law to treat.
Reportedly, the White House believes that all of the states will go for the expansion, since they all participate in Medicaid now with considerably less federal funding help than the new law provides. But as a student of bullheaded Tea Party extremism, I can tell you that I suspect more than a few red states will opt out of providing more health services to those folks—many of whom are ongoing victims of Republican economics—who can’t afford them otherwise.