Over the past half-century, Medicare and Medicaid have constituted the bedrock of American healthcare, together providing insurance coverage for more than 100 million people. Yet these programs remain controversial: clashes endure between opponents who criticize costly, “big government” programs and supporters who see such programs as essential to the nation's commitment to protect the vulnerable.
The post Medicare and Medicaid myths: setting the 50-year record straight appeared first on OUPblog.
The national headlines following the 2014 Midterm elections trumpeted the Republican success in seizing the majority in the US Senate and expanding its strength in the US House to record numbers since 1929. These wins were striking but hardly surprising given the tsunami of polls. The big news that continues to elude commentators are the Republican wins in gubernatorial elections – wins that may well have more impact on everyday lives than the Washington battle that pits a Republican Congress against President Barack Obama’s veto pen. Republicans not only pulled out wins in hotly contested battles in Florida, Kansas, Maine, and Wisconsin, but they also invaded Democratic strongholds by prevailing in Illinois, Maryland, and Massachusetts.
Will the GOP gubernatorial wins sweep in a revolution that, among other things, wipes out Obamacare’s centerpiece – the state’s decision to expand Medicaid? Many commentators are predicting just that – repeal or blockage of health reform. They often point to the fiery partisanship in Washington.
The talking heads are wrong. The raw partisanship in Washington cools in the hands of governors facing the nitty-gritty job of running their states – searching for revenues to design budgets and addressing the pressure from doctors and hospitals and advocates for the vulnerable.
Partisanship has been a tractor beam on many states. Democratic states have moved faster and further towards expanding Medicaid than their Republican counterparts, providing some credence to the recent reports that new Republican governors will hinder reform. What is striking, however, is that partisanship – and particularly steadfast GOP opposition to reform — has often been moderated or overridden by the real-world circumstances facing governors. What could possibly convince a politically skilled GOP governor to take on their party on such a high profile issue?
Carrots. The decision to adopt the expansion of Medicaid rests with states. The federal government has served up an enticing financial package: 100% of the costs for the first three years of the program and 90% afterward.
Hospitals that serve the uninsured and poor are facing dramatic reductions in federal government funding, leaving many to worry about dire financial crises. Medicaid expansion is a lifeline for these providers. It also may help state budgets by picking up the cost of caring for the uninsured, what is known as “uncompensated” or charity care.
Here is one of the most striking patterns in our era of partisan polarization: states with Republican governors in Arizona, Ohio, Michigan, Iowa, New Mexico, Pennsylvania, New Jersey, and others embraced Medicaid reform. In Arizona for example, conservative firebrand Governor Jan Brewer forced Medicaid reform through the state legislature as an imperative to create jobs, save hospitals, and ensure coverage for Arizona residents. Governor John Kasich passed it by going rogue on his Republican legislature by circumventing them altogether and risking a constitutional crisis.
The Republican recent romp has elected a new crop of pragmatic governors. Maryland Governor-Elect Larry Hogan and Illinois Governor-Elect Bruce Rauner seem poised to find a path forward to implementing reform. Florida’s Scott has supported Medicaid expansion in the past and may find more support in the GOP legislature now that the election is over. Some Republican governors favor reform in a modified form so they can publicly frame it as a “conservative model” that fits their states.
A new normal is arriving. The uncompromising push to repeal Obamacare is being replaced with a pragmatism geared to solving real problems. The irony of the GOP gubernatorial success in 2014 is that it may mark the turning point from vitriolic partisanship to real-world problem solving.
Headline image credit: Election vote. CC0 via Pixabay.
The post Why Republican governors embrace Obamacare appeared first on OUPblog.
This girl is reading the entire Patient Protection and Affordable Care Act out loud. [Act of Law]
Why no smoking signs actually ENCOURAGE smokers to light up [Daily Mail]
Think there’s no point in keeping print books around? I respectfully disagree. [Unshelved]
Here are some kitties crashing into each other. [YouTube]
100,000 staples arranged over 40 hours and other awesome staple art [NextWeb]
What does your literary tote bag say about you? [Vol1Brooklyn]
QUIZ: Can you tell Arial from Helvetica? [Ironicsans]
INFOGRAPHIC: The hardest languages to learn [Column Five]
This article on “Asian-American overachievers” is certainly creating a stir. [NYMag]
Incredible photos of the Great Flood of 1927 [Buzzfeed]
By Elvin Lim
The vitriol that liberals and conservatives perceive in each other is only the symptom of a larger cause. There is something rooted in the two ideologies that generates anger and condescension respectively, and that is why a simple call by the President for participants to be more civil will find few adherents.
Liberals are thinking, what is it about conservatism that it can produce its own antithesis, radicalism? Whether these be conservatives of the anti-government variety, such as Timothy McVeigh (Oklahoma City bomber) or Ted Kaczynski (the Unabomber), or conservatives of the anti-abortion variety such as Clayton Waagner, Eric Rudolph, or the Army of God -all conducted terrorism to preserve a way of life.
One of the deepest paradoxes of American conservatism is that the preservation of the past takes effort. As William F. Buckley put it, conservatives “stand athwart history, yelling Stop.” As the Founder of modern American conservatism noted, the enemy is History itself, because History moves. Congressman Joe Wilson took Buckley’s yelling advice to heart in 2009, when he blurted out “You lie!” to the President when he was addressing the Congress in the chamber of the House. Yelling is a far cry from shooting. But the point is that conservatism on this side of the Atlantic wasn’t exactly born a phlegmatic creed.
Conservatism in America has always been about fighting back and taking back, articulated with a healthy dose of bravado and second amendment rhetoric. Sarah Palin understands this and that is why her crowds cheer her on. People like her because she is feisty. But that has also worked against her. Palin just couldn’t help herself but fight back when she was accused of inciting Jared Loughner into his shooting frenzy. Whereas the very liberal John Kerry thought he was above the fray and was slow to respond to the Swift Boat veterans’ attacks against him, Sarah Palin is often too quick to respond to her attackers, and sometimes she does so without having considered her choice of words (like “blood libel.”)
That is why House leaders about to stage a vote against Obamacare are about to traverse a dilemma-ridden path. To say what they want to say requires outrage and gusto, but when they do this they risk being accused of giving fodder to the would-be Jared Lee Loughners in their midst.
This is not to say that there isn’t vitriol on the liberal side. But it is of an entirely different form. Whereas conservatives are apt to feel anger, liberals project condescension. Again, part of this is structural, because Progressivism of any variety has one thing on its side – history itself. Because in the long run, Progressives have change on their side, they only need to wait and the world as conservatives know it shall pass. This, in part, explains liberal condescension. Conservatives conserve because they want to insulate themselves against the vicissitudes of life and History’s inexorable movement. Progressives or liberals, on the other hand, embrace change because they feel it is inevitable.<
