Red-State Health Care - Gut It Out

December 13, 2013
Posted by Jay Livingston


George W. Bush at least talked about “compassionate conservatism.” The phrase was a response to the image of Republicans as cold-hearted. Rather than risk poor people becoming dependent on government, conservatives espoused principles of rugged individualism: you’re on your own no matter what.

Republicans today don’t even talk about compassion. Mostly, it seems, they just want to see Obama and anything connected with him fail. If that means punishing poor people, too bad.

A Supreme Court decision allowed states the option of refusing to go along with the Medicaid expansion that was part of Affordable Care Act (Obamacare).  Republican-controlled states are refusing to take federal money that would allow poor people in those states easier access to Medicaid. 

An article and video by Laura Ungar in the Louisville Courier-Journal compares Kentucky, one of the few red states to accept Medicaid expansion, with Indiana just across the border. What is the income ceiling on eligibility for Medicaid. Accoriding to Indiana’s unexpanded Medicaid regulations, if a working mother of two earns more than $4,687 a year, she’s too rich to deserve Medicaid.

 To be fair to the Hoosier state, the news article adds:

Indiana also has an alternative Medicaid “demonstration project” called the Healthy Indiana Plan, which the federal government recently extended through 2014. The program includes a health savings account and cost-sharing by participants, and doesn’t cover all the services covered by traditional Medicaid. It has a long waiting list.

Individuals with no children generally cannot get Medicaid in Indiana. The Healthy Indiana Plan is unavailable to individuals earning more than $11,490 nearly 30% lower than Medicaid. 

An Indiana woman in the video says,

For Louisville to have it and our people not when we are fifteen minutes away from each other, it’s just criminal. I am sorry, but I think it’s criminal that we’re not doing Medicaid expansion.

The 2012 Court decision allowing states to have different policies on Medicaid expansion upholds the principle of federalism – that states are “laboratories of democracy.”  It’s just that in this case, when you leave the Kentucky lab and walk into the Indiana lab, you’ll see a lot more poor people needing medical care. Instead, as the woman said, they rely on “over-the-counter medications.  And gut it out, just gut it out.”

 “Gut it out” pretty much summarizes the rugged-individualism theory of the state, and exponents of that theory will surely admire this woman. But I get the impression that this woman – unable to afford health insurance for the last 21 years – would gladly trade some of that admiration for affordable health care and would not mind at all if Indiana did something to make her individualism a little less rugged.