The U.S. Supreme Court ruling validating the constitutionality of the Affordable Care Act has done nothing to quell noisome resistance to that legislation from some Republican governors.
Led by Texas Gov. Rick Perry, modern-day secessionists declare they prefer to have millions of citizens continue to go without health care coverage rather than accept money from the federal government to cover those citizens through Medicaid.
In Texas alone, that expansion – entirely paid for by the federal government – would benefit nearly two million people. Foregoing it means Texans with insurance will continue to subsidize the costs of the uninsured receiving billions of dollars in uncompensated care from hospitals. Talk about a tax!
Not to be outdone, Perry is joined by Govs. Rick Scott of Florida, Bobby Jindal of Louisiana, Phil Bryant of Mississippi and Nikki Haley of South Carolina.
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The incongruity of this posturing is that these states are already bloated with federal largesse. Arguably the size of the existing Medicaid trough grows based on the “redder” the state is. Yet we hear no complaining about this.
Take Texas (please): Through the matching mechanism known as the Federal Medical Assistance Percentage – or FMAP – the federal government pays just over 58 cents of every $1 spent on Medicaid. But that’s a pittance compared to what’s shelled out in the other states Perry has allied with. The feds pick up 61 percent of Louisiana’s Medicaid spending, 70 percent of South Carolina’s and a whopping 74 percent of Mississippi’s.
This is the money that goes to pay for care for the medically indigent elderly and infirm in nursing homes or other long-term care settings. The last Tax Foundation study showed Mississippi receiving more than two federal tax dollars for every one its citizens pay.
Meanwhile, Washington state has reason to feel blue – it’s tied for the worst FMAP rate of 50 percent. That’s because the FMAP is based upon per-capita income, with the presumption that states with higher incomes have higher revenues to maintain their safety nets themselves.
Washington’s high-tech billionaires skew its average income, quite apart from myriad multimillionaires made rich by companies like Amazon, Microsoft and Starbucks. Because we have no corporate or personal income taxes, however, there’s no way of capturing this. That negates the FMAP mechanism’s premise.
Of the states with the lowest FMAP, Washington is one of only four with no income tax. We may never have one. Two of the other three states, Alaska and Wyoming, sustain budgets on oil and mineral resource revenue. The other, New Hampshire, has a high business profits tax and otherwise contents itself with slashing programs through dysfunctional governance with a 400-member state House that does things like declare that abortion causes breast cancer.
The FMAP is the sort of income-based redistributive scheme Perry and his cohort rhetorically decry. Authentic conservatives should have the courage of free market convictions and refuse perverse incentives that reward the worst economic basket cases. They should, instead, have all states equally divide the Medicaid pie.
Our state could certainly use the help as it wrestles with the inexorable budget conflict between funding education and care for an aging medically indigent population. We can’t do right in both areas within existing means, and a higher FMAP would help.
And as for a Medicaid expansion for the uninsured, it’s an economic no-brainer: Why refuse a return of tax dollars? Providers, our economy and the already-insured would benefit from a federally funded reduction in more than $1 billion in uncompensated care provided annually in our state.
Olympia resident Brendan Williams is a former state representative and a disabilities’ advocate.