By rejecting state health insurance exchange, GOP governors increase the scope of federal government

These past few days, I’ve been thinking a lot about my brother’s death at the age of 49.  When he fell from a ladder and smashed his brains on the concrete below, he was worth about $100.  Yet he got the finest, most high-tech treatment available by first class specialists who respected and maintained his life until it was hopeless, then cut out his useable parts for the living.

And it was all free.

The best medical treatment in the world for free for an itinerent skilled laborer—and he got it at the Charity Hospital in New Orleans, which was founded in 1736 and at one time was the second largest hospital in the country. It never reopened after Hurricane Katrina, most assuredly for political reasons.

My thoughts have turned to the wonderful care my brother received because of the announcement by Louisiana Governor Bobby Jindal that he was acting for the entire state and rejecting key portions of the Affordable Care Act. How far has Louisiana  fallen when it comes to taking care of its citizens!

Jindal has now been joined by his fellow right-wing ideologue Florida Governor Richard Scott, who is also rejecting those portions of the new health care law over which the states have control.

In the case of both of the provisions that Jindal and Scott have rejected, the governors are cutting off the noses of their constituencies to spite their own faces in a near paroxysm of ideological purity.

First, their refusal to construct state health insurance exchanges (HIX), which are state markets on which different insurance companies offer policies built on state-mandated standards to uninsured citizens of the state.  The Affordable Care Act gives every state the option to create an HIX, but the citizens of those states who decide not to create an one will be able to buy insurance on the federal version. In other words, by blocking Louisiana and Florida HIXs, Jindal and Scott are directly leading to an increase in federal government intervention on a state level because people who would have bought insurance through a state HIX will now go to the federal HIX.  I guess their opposition to social service programs to help the needy supersedes their dedication to states’ rights.

Ideological purity will lead to a net transfer of money from the pockets of Louisianans and Floridians because their governors are also rejecting an increase in the Medicare program.

I get it that both would like to replace Medicare with either a voucher system or, alternatively, end all government support of health care for the elderly.  But let’s look at the facts on the ground: Medicare as it exists right now is being expanded to serve millions of new people.  All of this expansion will be completely financed on the short term by the federal government and mostly financed by the feds in the long run. For every dollar that a state puts into the expansion in the future, it will receive many, many dollars from the feds both now and later. All of this money will go to making their citizens healthier.  Moreover, the citizens of every state will have to pay taxes to support the Medicare expansion, whether or not they receive the benefits.  Thus, by refusing to participate, a state is making its citizens pay for the health care of the citizens of other states.

In both refusals, the good governors are perversely working against their own cause. By not creating an HIX, they increase federal government control of the local health insurance market using federal not state standards. By turning down the Medicare expansion, they take money out of the pockets of their citizens and give it to the citizens of other states, a de facto tax increase with no benefit to those taxed—just the kind of thing about which Rick and Bobby like to pontificate.

Laughable on the level of ideas, but truly tragic when we think of the hundreds of thousands of people in these two states who will not get adequate health care because of these heartless ideologues.  It’s a sad day for both Louisiana and Florida.


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