Cruel to be kind on Medicaid expansion?

Efforts to repeal ACA have run into real political trouble. Even in Arkansas and other conservative states, angry town hall crowds are berating Republican legislators over the issue. President Trump’s poll numbers are sinking. For the first time, the majority of Americans express support for ACA, too. Efforts to roll back ACA’s Medicaid expansion have proved particularly difficult. Democratic and Republican Governors oppose the idea. So do many other key constituencies.

The politics changed after November 8 because the real choices are starkly before us: If ACA is repealed, what will actually happen to millions of vulnerable Americans who rely on ACA for essential health care and coverage?

Facing these stark questions, some conservatives bluntly maintain that we should snatch health coverage from millions of people. The brutality of such arguments makes them politically self-immolating. So the search is on for kinder and gentler talking points against the ACA. In a creative bit of political jujitsu, conservatives argue that Obamacare itself harms the vulnerable, and that we must repeal ACA to really help the most deserving.

A particularly brazen argument is now making the rounds. On this account, ACA’s Medicaid expansion for able-bodied poor people harms the most vulnerable by siphoning away state funds that would otherwise finance disability services. If you aren’t steeped in Medicaid or disability policy, this argument sounds plausible.

I consider the realities here, at

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

One thought on “Cruel to be kind on Medicaid expansion?”

  1. Lies like Horton's are signs of desperation. Paddy Power's (probably quite thin) book gives ACA repeal at 5:2 on. These odds look high to me. John Boehner, from the comfort of his retirement, thinks it won't happen. From CNN:

    "They'll fix Obamacare," the former Ohio congressman predicted at a conference hosted by the Healthcare Information and Management Systems Society in Orlando, Florida. "I shouldn't have called it repeal and replace because that's not what's going to happen. They're basically going to fix the flaws and put a more conservative box around it."

    Republicans simply cannot agree on health care, as they have shown over the last 6 years. Add to this that the Trump White House is clearly incapable of leading Congressional Republicans to a negotiated compromise, which would require vision, knowledge, patience, persuasiveness, guile and secrecy, none of which they can offer. Price is on his own.

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