An Interesting Correlation

Well, it’s been a couple of weeks now since the passage of health insurance reform.  So far no one’s grandma has been whisked away in a black van (or helicopter) to a death panel hearing, no small businesses have had to close their doors due to the tyranny of increased taxation, and so far we aren’t being forced to salute the hammer & sickle or sing the Internationale. 

But it’s not all peachy.  In the past week alone, several individuals have been arrested for making threats against elected officials; right-wing media, rather than condemning the threats, has tried to portray them as the “understandable” reactions of people who are terrified of “losing their freedom” – in large part the result of their large daily consumption of right-wing media’s insistence that they are losing their freedoms.

It would be nice to see some sort of intellectual honesty and personal responsibility demonstrated on the part of the leadership of the right – which these days, IS the right-wing media, but apparently that would be asking too much. 

It seems it would also be asking too much to ask states’ attorneys general not to waste time and money grandstanding by suing over the new law on the basis of some supposed “infringement on states’ rights.”  (You just knew that phrase was going to be resurrected at some point, didn’t you?)  Two and a half weeks ago, 14 attorneys general filed suit:

In addition to Florida, participating plaintiffs in the lawsuit include attorneys general from South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Michigan, Colorado, Pennsylvania, Washington State, Idaho, and South Dakota. The suing attorneys general are Republicans except James “Buddy” Caldwell of Louisiana, who is a Democrat.

The lawsuit is specious to begin with, since no state is being “forced” to be a part of the national program.  An amendment placed in the bill by Oregon Senator Ron Wyden allows states to “opt out” of the individual mandate, provided they devise a way to meet the requirements of the bill.

“The only catch to the amendment is that if a state opts-out or the plan, it must set up its own health care system that meets the coverage requirements in the bill. However, the state system can choose to include or not to include an individual mandate; or the state system could choose to include a public option, unlike the federal system.

“Why would you just say you are going to sue everybody, when this bill gives you the authority and the legal counsel is on record as saying you can do it without an individual mandate,” Wyden asked the Huffington Post.

However, Florida Attorney General Bill McCollum is undeterred, despite what is or isn’t in the new federal health care law.

The Attorney General’s office said the amendment doesn’t affect the lawsuit because the individual mandate on its face is unconstitutional and oversteps the authority Congress possesses.”

Ummm…no.  Without the opt-out amendment, that might have been a winning argument.  With the opt-out on the table, it goes nowhere, for the simple reason that a state that objects to having the mandate imposed on its citizenry has an alternative.  Massachusetts could opt-out because they’ve already got a system in place; any other state could do the same.  It’s kind of hard to claim that health insurance mandates are being “shoved down your throat” when essentially you have the option of saying, “no thanks.”

The issue here (besides pandering to teabaggers) then boils down to this:  states don’t want the federal government to fix the health insurance system, but they also don’t want to have to do it themselves.

So I thought it would be interesting to see how much of it they’re actually doing for themselves right now.  The following are the federal Medicaid matching funds rates for the various states for FY 2011.  Matching rates are determined based on average per-capita income in the states, have a minimum 1-to-1 match (no state or territory gets less than $.50 in federal money for every $.50 they spend on Medicaid), and can range all the way up to 83% (where the feds contribute $.83 of every Medicaid dollar, to match the state’s $.17).

To be honest, I expected a much higher correlation between high-matching rate states and states filing lawsuits.  That doesn’t seem to be there so much, though it’s partly because of Democratic AGs in states like Arkansas and Georgia refusing to join in a quixotic battle against the legislation (and facing calls for impeachment as a result, in the case of the Georgia AG).  But it is interesting to note the correlation between high Medicaid matching rates and Teabag Nation.  I’ve bolded the states that are participating in the lawsuit and added an asterisk to those where Teabaggery has gained the most traction:

  Federal Register/ Vol. 74, No. 227 / Friday, November 27, 2009 / Notices 62317

FEDERAL MEDICAL ASSISTANCE PERCENTAGES AND ENHANCED FEDERAL MEDICAL ASSISTANCE PERCENTAGES, EFFECTIVE OCTOBER 1, 2010–SEPTEMBER 30, 2011

[Fiscal year 2011]

State

Federal medical assistance percentages/Enhanced federal medical assistance percentages

*Alabama ………… 68.54 /77.98

*Alaska ……………. 50.00 /65.00

American Samoa  …. 50.00 /65.00

*Arizona ………….. 65.85 /76.10

*Arkansas …………. 71.37 /79.96

California ……….. 50.00 /65.00

Colorado ………… 50.00 /65.00

Connecticut …….. 50.00 /65.00

Delaware ………… 53.15 /67.21

District of Columbia  ….. 70.00 /79.00

Florida ……………. 55.45 /68.82

*Georgia …………… 65.33 /75.73

Guam …………….. 50.00 /65.00

Hawaii …………….. 51.79 /66.25

*Idaho ………………. 68.85 /78.20

Illinois ……………… 50.20 /65.14

*Indiana ……………. 66.52 /76.56

Iowa ………………… 62.63 /73.84

*Kansas …………….. 59.05 /71.34

*Kentucky …………… 71.49 /80.04

*Louisiana ………….. 63.61 /74.53

Maine ……………….. 63.80 /74.66

Maryland ……………. 50.00 /65.00

Massachusetts ……… 50.00 /65.00

Michigan …………….. 65.79 /76.05

Minnesota ……………. 50.00 /65.00

*Mississippi …………….. 74.73 /82.31

*Missouri ………………… 63.29 /74.30

*Montana ……………….. 66.81 /76.77

*Nebraska ……………….. 58.44 /70.91

Nevada …………………. 51.61 /66.13

New Hampshire ………. 50.00 /65.00

New Jersey …………….. 50.00 /65.00

New Mexico ………………… 69.78 /78.85

New York …………………….. 50.00 /65.00

*North Carolina ………………. 64.71 /75.30

*North Dakota …………………. 60.35 /72.25

Northern Mariana Islands  ….. 50.00 /65.00

Ohio ……………………………… 63.69 /74.58

*Oklahoma ……………………… 64.94 /75.46

Oregon ………………………….. 62.85 /74.00

Pennsylvania …………………. 55.64 /68.95

Puerto Rico  …………………… 50.00 /65.00

Rhode Island ……………………. 52.97 /67.08

*South Carolina ………………….. 70.04 /79.03

*South Dakota …………………….. 61.25 /72.88

*Tennessee …………………………. 65.85 /76.10

*Texas ………………………………… 60.56 /72.39

*Utah …………………………………… 71.13 /79.79

Vermont ……………………………… 58.71 /71.10

Virgin Islands  ……………………. 50.00 /65.00

*Virginia ……………………………….. 50.00 /65.00

Washington ………………………….. 50.00 /65.00

*West Virginia ……………………….. 73.24 /81.27

Wisconsin ……………………………. 60.16 /72.11

*Wyoming ………………………………. 50.00 /65.00

*Update:  Arizona and Nevada joined the 14 states previously mentioned last week.

It’s not an exact correlation, but note how many of those states where teabaggery is rampant feature the feds funding well over half of all Medicaid expenditure.  I may have left a few of the states deserving of inclusion in Teabag Nation off the list, also – I wasn’t quite sure about Nevada, or Florida, Ohio, Colorado, and Pennsylvania.  So keep in mind that this isn’t that scientifical – it’s more a quick-strokes look at things. 

What I’m curious about is this:  suppose one or more of these states, after losing their lawsuit, decides that they’re going to thumb their nose at the feds and not comply with the mandate, and also refuse to set up a state plan that meets the guidelines – can the feds then use Medicaid funding as a stick?  If a state is out of compliance, because it doesn’t participate in the mandate or offer a state plan, can the feds reduce or cut off its Medicaid matching funds?  Because if there’s a quicker way to bankrupt the medical systems, small businesses, and individual citizens of a poor state heavily reliant on the rest of the nation for providing care to the poorest of its citizens, I can’t think of one. 

The AGs who have filed this suit are arguing that it’s unconstitutional to “force” a state to make its citizens buy insurance, even though the law as written forces states to do no such thing, since they have an option – an option that need not include individual mandates to purchase insurance.  The courts will decide whether their argument has any merit or not; I believe they will decide in the negative.  

But here’s something I’m pretty sure IS entirely constitutional, and we don’t even have to ask a judge:  the federal government has the right to tie strings to the money it sends to the states.  In the case of states in noncompliance, the feds would not only be entirely justified in cutting off Medicaid funding, they’d be fiscally remiss in not doing so, since states in noncompliance would essentially become free riders on the backs of all the other states and continue to drive costs up for everyone. 

Just as the federal government got compliance on raising the drinking age to 21 in all the states by threatening to withhold federal highway funds to states that didn’t comply, it can require medical coverage reform in ALL the states – whether by participation in the national plan or through a plan of their own device – by using Medicaid matching funds as leverage.

The only question remaining is:  is there anything in the Medicaid law that prohibits the feds from tying strings to matching funds?  Maybe some friendly lawyer will wander by and answer that question.  If the answer is no, I fully expect for these funds to be used as leverage, and for Teabagger states to have a come to Jesus moment where they decide that they’re less concerned with the “individual freedom” of their citizens than they are with losing all that sweet, sweet federal cash.