Over at healthinsurance.org, I interviewed MIT economist Jon Gruber on the state of ACA. Â We discussed a huge range of things, ranging from the case for the “Cadillac tax” to lessons of the botched rollout. It was a pretty upbeat conversation. But Jon was characteristically blunt regarding states that have declined ACA’s Medicaid expansion:
Jon:Â I think, Harold, the single thing we probably need to keep the most focus on is the tragedy of the lack of Medicaid expansions. I know youâ€™ve written about this. You know about this, but I think we cannot talk enough about the absolute tragedy thatâ€™s taken place. Really, a life-costing tragedy has taken place in America as a result of that Supreme Court decision. You know, half the states in America are denying their poorest citizens health insurance paid for by the federal government.
So to my mind, Iâ€™m offended on two levels here. Iâ€™m offended because I believe we can help poor people get health insurance, but Iâ€™m almost more offended thereâ€™s a principle of political economy that basically, if youâ€™d told me, when the Supreme Court decision came down, I said, â€œItâ€™s not a big deal. What state would turn down free money from the federal government to cover their poorest citizens?â€ The fact that half the states are is such a massive rejection of any sensible model of political economy, itâ€™s sort of offensive to me as an academic. And I think itâ€™s nothing short of political malpractice that we are seeing in these states and weâ€™ve got to emphasize that.
Harold:Â One of the things thatâ€™s really striking to me is thereâ€™s a politics of impunity towards poor people, particularly non-white poor people that is almost a feature rather than a bug in the internal politics in some of these states, not to cover people under Medicaid, even if itâ€™s financially very advantageous to do so. I think thereâ€™s a really important principle to defeat this politically, not just because Medicaid is important for people, but because itâ€™s such a toxic political perspective that has to be â€¦ It has to be shown that that approach to politics doesnâ€™t work because otherwise, we will really be stuck with some very unjust policies that will be pursued with complete impunity in some of these places.
Jon:Â Thatâ€™s a great way to put it. There are larger principles at stake here. When these states are turning â€“ not just turning down covering the poor people â€“ but turning down the federal stimulus that would come with that.
They are not just not interested in covering poor people, they are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.