Obamacare has brought out “a startling ugliness of spirit” in America.
So wrote Paul Krugman earlier this month, referring to the choice of some states not to expand Medicaid. This decision, he asserted, “appears to be motivated by pure spite.” That is, Republican governors and legislators weren’t concerned about the bloated size of government and ever increasing debt; their goal, rather, was “denying health care to millions of vulnerable Americans” for no other reason than just to try to undermine the Obama administration’s health care reform.
And, Krugman adds, “it’s already quite easy to find examples of people who died because their states refused to expand Medicaid.”
He was referring to Florida resident Charlene Dill, who died of heart condition. Reportedly, she was prescribed medication for her condition but had run out and couldn’t afford to buy any more. Her income was too high to qualify for Medicaid, but too low to qualify for a subsidy through the Obamacare insurance exchange. She was a victim, we are told, of a “coverage gap”. Krugman looks at this case and he sees that the state of Florida decided not to expand Medicaid and therefore blames Ms. Dill’s death on the politicians who voted against expansion.
This view is premised on the assumption that it is the role of government to provide health insurance to everyone and that it should do so by using force to expropriate wealth from some people in order to redistribute it to others. One may debate this assumption. However, even if we accept this view, and even if we accept the assertion that Republicans are willing to put people’s lives at risk in order to play problems, there is a glaring shortcoming in Krugman’s criticism.
He doesn’t think to ask the obvious question: why couldn’t Charlene Dill just get a subsidized health plan through the Obamacare marketplace?
The answer isn’t that it’s the Republicans‘ fault. While Republicans may be responsible for Dill not being able to qualify for Medicaid, they are not responsible for her not being able to qualify for a subsidy to purchase insurance through the exchange. The Obama administration, the crafters of the law, and its mainly Democratic supporters are responsible for that. Their goal was to try to force poorer people into Medicaid instead of obtaining a private health insurance plan. To accomplish this, the law was deliberately crafted so that a) states would have to expand Medicaid, and b) people whose income fell below a certain level who would therefore be eligible for Medicaid would not be able to qualify for subsidies to buy a plan through the marketplace.
The first part of that strategy fell apart when the Supreme Court ruled that the federal government has no authority under the Constitution to force states to expand Medicaid, that this must remain a matter of choice. The second part of it, however, remained in effect. This is the reason it was possible for Charlene Dill to have made too much income to be able to get Medicaid and yet at the same time not be able to get a subsidy to buy a private plan through HealthCare.gov.
So Krugman is correct. There is “a startling ugliness of spirit” in America and a willingness of politicians to risk lives just to play politics. It’s just that, contrary to what he would have you believe, this ugliness is not limited to Republicans, but just as much a characteristic of the Democrats who, in their push towards a “single-payer” system by trying to force the least affluent onto a government health plan, were, by the same standard Krugman uses, responsible for the death of Charlene Dill.