This
week, GOP White House frontrunner Mitt
Romney marked the two
year anniversary of the Affordable Care Act by declaring the reform law
the "national nightmare" he "always predicted." But leaving
aside for the moment that Romney
repeatedly touted his virtually identical Massachusetts law as a model
for the nation, there's a much bigger problem with his call for a "free
market, federalist approach" in which "each state should be allowed
to pursue its own solution." As Ezra
Klein exhaustively documented five years ago, it's almost impossible
for even the wealthiest of those state "laboratories of democracy" to
achieve universal health care on their own. Worse still, Romney's mythical
nightmare future is the horrifying present in the states his party currently
represents. As the data show, health care is worst precisely where
Republicans poll best.
That
point was reinforced last week with the latest
Gallup poll on the uninsured in America. With almost 28 percent of
respondents uninsured, Texas far and away led the nation as well as the "uninsured
belt" that stretches across the solidly red south. Led by Mitt
Romney's Massachusetts, 9 of the top 10 performing states voted for Barack
Obama in 2008.
But
tallying up the ranks of the uninsured understates the magnitude of
the unfolding health care horror story in Red State America. Two years ago, the
Commonwealth
Fund released its 2009
state health care scorecard, which measured performance in providing
health care access, prevention and treatment, avoidable hospital use, equity
across income levels, and healthy lives for residents. Again, while nine of the
top 10 performing states voted for Barack Obama in 2008, four of the bottom
five (including Arkansas, Mississippi, Oklahoma and Louisiana) and 14 of the
last 20, backed John McCain. (That at least is an improvement from the 2007 data,
in which all 10 cellar dwellers had voted for George W. Bush three years
earlier.)
In
December, the "America's
Health Rankings" project echoed those findings. And in 2009,
another UnitedHealth Group-funded study similarly showed that red
state residents are the unhealthiest in America. With Vermont topping
the list and Mississippi bringing up the rear, Americans would do to listen to
Dr. Howard Dean and not former Governor Haley Barbour when it comes to the
health care debate.
The
ironies of the Republicans' crusade to prevent their own constituents from
getting health care aren't limited to geography. Left unsaid is that the
dynamic of "red
state socialism" applies to health care. That is, the one-way flow
of blue state tax dollars to Washington DC to fund programs in red states is
already at work.
Currently,
the $300
billion Medicaid program serves roughly 60 million Americans. On
average, the federal
government picks up 57 percent of the tab, with poorer states like
Mississippi and Alabama getting 75 percent of the funding from Washington. Averaging
21.8 percent of states' spending, Medicaid is now the largest budget
item for most. Medicaid not only pays for a third of nursing home care in the
United States; it covers a third of all childbirths. In Texas, the figure is
one-half.
In
May 2009, the Washington Post ("A
Red State Booster Shot") explained how national health care reform
would ultimately have to work — and have to be funded:
Health-care reform may be overdue in a
country with 45 million uninsured and soaring medical costs, but it will also
represent a substantial wealth transfer from the North and the East to the
South and the West. The Northeast and the Midwest have much higher rates of
coverage than the rest of the country, led by Massachusetts, where all but 3
percent of residents are insured. The disproportionate share of uninsured is in
the South and the West, the result of employment patterns, weak unions and
stingy state governments. Texas leads the way, with a quarter of its population
uninsured; it would be at the top even without its many illegal immigrants.
Which
is exactly right. With the full
implementation of the Affordable Care Act beginning in 2014, federal
assistance to under-served red states will only increase. The expansion of
Medicaid to families earning 133 percent of the federal poverty level and the
availability of subsidies to those at four times the FPL will enable coverage
for 30 million more people nationwide.
Nevertheless,
Republican
state attorneys general are hoping to overturn the Affordable Care Act
in the Supreme Court, if not in Congress. Once again, the reddest of red states
are most mobilized to undo the dreaded "Obamacare" where the need for
it is greatest:
Of
course, the final irony of the Republican assault on health care reform is Mitt
Romney himself. In Massachusetts, the 2006 health care reform bill then
Governor Mitt Romney signed into law lowered the uninsured rate from 10 percent
to a national
low of two percent. Even with its individual mandate,
"Romneycare" is extremely
popular enjoying a 3 to 1 margin of support from Bay State residents.
Now, a new study by Charles J. Courtemanche and Daniela Zapata published by the
National Bureau of Economic Research (NBR) shows that universal coverage in
Massachusetts is indeed making people there healthier. As Ezra
Klein of the Washington Post summed up their findings:
The answer, which relies on self-reported
health data, suggests they did. The authors document improvements in
"physical health, mental health, functional limitations, joint disorders,
body mass index, and moderate physical activity." The gains were greatest
for "women, minorities, near-elderly adults, and those with incomes low enough
to qualify for the law's subsidies."
Those
Massachusetts residents who benefit from health care reform today fit the same
profile of those red staters who will be helped by the Affordable Care Act in
the future. (And as MIT
professor Jonathan Gruber, who worked on both pieces of legislation,
explained, "they're the same f--king bill.") But if Mitt Romney and
his Republican allies are successful in repealing The Affordable Care Act, red
state Americans will continue to suffer their sadly ironic fate.
That
is, health care is worst where Republicans poll best.
(This piece also appears at Perrspectives.)