THE STUMP APRIL 10, 2012
I’m a bit late coming to this, but I haven’t seen anyone else draw attention to it and I can’t let it pass without comment. The Wall Street Journal’s lead editorial on Friday praised Rhode Island’s efforts reining in Medicaid costs after having gotten special flexibility from the Bush administration, and argued that this demonstrated the wisdom of block-granting Medicaid to the states, as Mitt Romney and other Republicans are calling for. There’s a strong argument to be made on the other side that block-granting is just a cover for major Medicaid cuts, but leave that for another time. What really caught my eye was this:
Our guess is that President Obama’s real objection to Medicaid block grants is political. He doesn’t want Washington to lose control. He and most Democrats want to use Medicaid to cover as many people as possible as a way to pave the road to single-payer national health care. It’s no accident that ObamaCare was written to add about 15 million more people to the Medicaid rolls, most of whom will be middle-income earners.
There are two hilarious assertions in this paragraph. First is the notion that Obama sees the expansion of Medicaid as a route to single-payer health care. This is pretty rich. Obama is now at risk of having his new health care overturned by the Supreme Court precisely because he chose not to take a direct route to single-payer, by simply expanding Medicare or Medicaid to cover all of the uninsured. Instead, the new law seeks to cover many of uninsured by forcing people to buy private insurance. Yes, it also expands Medicaid. But the only way that it intentionally paves the way to single-payer health care is if it was explicitly designed to be struck down by the Supreme Court, thus leaving single-payer as the only other option. Somehow, I doubt that even the conspiracy-mongers on the right believe that Obama deviously plotted the nullification of his biggest legislative accomplishment.
But even more ludicrous is what comes next—that most of the 15 million people added to the Medicaid rolls will be “middle-income earners.” The Medicaid expansion is being carried out by setting a new nationwide threshold for Medicaid eligibility, to replace the patchwork of widely varying state levels. The new threshold is 133 percent of the poverty level. That, today, means $24,644 for a family of three and $29,725 for a family of four. Leave aside that most of the newly eligible will be earning well below that—in many states today (Texas, Virginia, and a whole bunch of others) adults, whether parents or childless, can earn well below $10,000 a year and still be ineligible for Medicaid. But even if most of the newly eligible were closer to the new national threshold—are these “middle income earners?” The median family income at the end of 2011 was $51,413. That is, more than double the new Medicaid eligibility limit for a family of three, and more than $20,000 higher than the new limit for a family of four. But to the chin-tuggers of the Journal op-ed page, families earning below $30,000 apparently qualify as “middle income earners.” Boy, the view from the Journal’s new offices at News Corp. headquarters in Midtown must be pretty obscured. We middle-income earning hoi polloi out around the country are having a rough time of it, but not that rough a time. But who knows, maybe as Obama’s secret plan for single-payer health care proceeds, even families earning $40,000 or $50,000 will qualify for the luxuries of Medicaid. Don’t tell anyone!
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