This comment thread on Seth Ackerman’s nuclear take on Medicaid is especially good. I want to highlight this one from fake irishman, responding to Ackerman’s claim that because the number of people on Medicaid increased even in states that didn’t take the expansion actually Republicans like Medicaid fine and both parties are the same:
One unheralded part of the ACA/Obamacare having to do with Medicaid imposed massively streamlined application standards on each states (which apparently wasn’t a gun to the head of the states or didn’t violate their solemn dignitude because the Supreme Court didn’t touch it). You had to be able to apply online, or via telephone, or in person, or via mail — no wrong door. It also eliminated asset tests (you didn’t have to spend yourself into penury to qualify) And finally, applications had to be short — a few clear, easy pages to fill out.
So, no more 50-page applications (like in Texas) or a 40-page application and an in-person appointment so you get yelled at for being a bad person (like in Arkansas). A source I have who used to work for HHS told me the Feds had to threaten to sue Texas to get them to reduce the length of their application.
Shockingly, the result of this streamlined application procedure was a lot more people who were ALREADY eligible under the old standards came out of the woodwork and successfully signed up.
So why did all these Republican controlled states that didn’t take the Medicaid expansion have increased Medicaid rolls in an expanding economy? Because the ACA mandated it.
Kaiser is indeed an immensely useful source.
Anyway, I’m almost beginning to think that the architects of the ACA were more concerned with expanding access to health insurance than BAILING OUT insurance interests! Indeed, this is obvious, which is precisely why the basic strategy of the “ACA is worthless neoliberal crap” crowd is to act as if the ACA consisted solely of one line, “You must buy the private insurance xthxbi — Grand Commander Gruber,” with both the historic Medicaid expansion and onerous regulation of insurers going straight down the memory hole. And while the ACA was indeed kludgier than most liberals would prefer, obscure things like “the process that led to the ACA’s passage” and “the entire history of the development of the American welfare state passim” strongly suggests that this kludginess was more a result of a bunch of red state legislators having individual veto points that an inherent liberal preference for complexity for its own sake.
This is also an excellent point by Denverite about the silly assumption that hospitals were big ex ante fans of the Medicaid expansion:
This is just ignorant. Prior to the ACA, there was a Hospital Back-Up program that essentially reimbursed hospitals if they lost too much money on providing “free” care to the uninsured. Now, the ACA took that away and replaced it with Medicaid expansion, so *after* the ACA hospitals have been in favor of expansion (because that’s how they get paid!), but beforehand they would have been (and were) indifferent.
As for the other health care providers, with one exception (long term care*), most providers break even or even lose money seeing Medicaid patients. That’s the point of Medicaid! Providers agree to see poor people and in return get that care paid for at cost. But, of course, lots of Medicaid claims get denied for silly administrative reasons, so the providers lose money. They wouldn’t be lobbying to expand Medicaid.
And the fact that John Roberts’s inept re-writing of the expansion screwed up this fundamental design is also one of the many reasons his acid-soaked, results-oriented adventures in doctrinal wonderland were highly injudicious.
Anyway, Ackerman’s crude monocausal analysis — let’s leave Marx out of it entirely — fails to explain the actions of either party. And when Republicans at all levels of government and all branches act to oppose and undermine Medicaid, well, res ipsa loquitur.