Medicaid Expansion Is Nearly Free, But Republicans Won’t Take It Anyway

Paul Krugman writes today about the fate of the rural poor in two neighboring states. Kentucky accepted Medicaid expansion while Tennessee didn’t:

According to a Georgetown University study that covered a seven-year period spanning the introduction of the A.C.A., the percentage of low-income rural adults without health insurance fell 27 points in Kentucky, only six points in Tennessee.

I clicked and took a look at the Georgetown study. Here’s what the rural uninsured rate looks like for all expansion states compared to all nonexpansion states:

In 2009, the states are pretty mixed up. By 2016, however, there’s virtually no overlap at all: it’s all red at the top and all blue at the bottom. On average, the expansion states reduced the uninsurance rate of their rural population by 19 percentage points. The non-expansion states reduced it by only 6 points.

And it’s all for nothing. Literally. Expansion cost the states nothing at the start and only a tiny amount past 2020. It was virtually free, and the funding came from taxes these states were paying regardless. There was no reason to refuse Medicaid expansion except for sheer spite toward Barack Obama or else simple hatred of providing services for the poor—or both.

I can barely conceive of the kind of mind that thinks this way. The cruelty and contempt for their fellow citizens is just jaw dropping. And then they go out and tell all these rural folks that only Republicans have their best interests at heart and Democrats just want to rob them blind. How do they sleep at night?


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