9/4/20

My father instilled in me the idea that if you have a dollar more than you need, you can consider yourself rich; but with a dollar less than you need, you’re poor. We’re living in an America today, where the portion of our population meeting that definition of poverty has exploded. The disparity between those living with financial insecurity versus those who have avoided this plague has always been a feature of America; but these days, exacerbated by the effects of the Covid-19 pandemic, those in financial need are both more plentiful, and more visible.

Meanwhile, no viable aid package seems to be forthcoming from congress anytime soon, and the administration’s executive orders relating to unemployment benefits fall far short of addressing the needs of those living with financial insecurity. The executive order provides for $300 per week of supplemental benefits funded by the federal government, but funds are limited, so disbursements are likely to dry up some four or five weeks after they start. Beyond the federal dollars, an additional $100 per week has been authorized if states elect to opt in; but these moneys come out of state coffers. So far, only five states have stepped up to that plate.

As of August 31, 10 states had not yet received approval to receive these funds from the federal government, though they expect to; and South Dakota has reportedly declined to participate in this program, altogether. Good to know that South Dakota’s political leadership is looking out for the wellbeing of those who are most vulnerable in their great state. Way to go, South Dakota!

We see the same kind of indifference to the plight of the financially insecure played out in connection with healthcare insurance. The Medicaid Expansion program, initiated in January 2014, was designed to increase health care coverage and improve access to care and health outcomes for enrollees, but it required states to opt into the program. Prior to this legislation, enrollment in Medicaid was determined, state by state, but the Medicaid Expansion program would over-ride any state eligibility criteria for Medicaid, making income, alone, the sole qualifying criterion. Under the program, the federal government would bear the lion’s share of the cost of coverage, with the states’ requirement capped at 10 percent of total costs.

According the Kaiser Family Foundation, a major producer of health care policy analysis and research, the program has delivered on its intended goals. “Most research demonstrates that Medicaid expansion has improved access to care, utilization of services, the affordability of care, and financial security among the low-income population.” Additionally, “Analyses find effects of expansion (of Medicaid) on numerous economic outcomes, including state budget savings, revenue gains, and overall economic growth. Multiple studies suggest that expansion can result in state savings by offsetting state costs in other areas.”

Despite these findings, 10 states elected to deny the opportunity for Expanded Medicaid coverage for their citizens: Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Wisconsin, and Wyoming. In seven out of 10 of these states, the Republican party controls the governorship and both houses of each state’s legislature and have done so since at least 2012 — i.e., before the Medicaid Expansion option was offered. In the three exceptions, Kansas, North Carolina, and Wisconsin, Democratic governors won in the most recent gubernatorial elections, but legislatures in those states continue to have Republican majorities.

It’s hard not to notice the predominance of the Republican party in this listing. Importantly, not all Republican dominated states have taken this posture, but equally telling is the fact that all Democratic-leaning states have elected to allow their constituents to participate. In any case it shouldn’t be lost on anyone that the failure of these above Republican-dominated states to participate in the Medicaid Expansion program directly disenfranchises many of their most vulnerable compatriots, but it also serves to inhibit our collective capacity to control and contain the Covid-19 pandemic.

Republicans at all levels seem all too willing to turn a blind eye to the dire straits of those lacking income and healthcare. The mean-spirited and short-sighted posture of the Republican response to income and heathcare insecurity reflects an attitude that falls right in line with “Let them eat cake.” How’d that work out for Marie Antoinette? Republicans should take note.

Kawaller holds a Ph.D. in economics from Purdue University.