If you have a hamster that runs all day on one of those little wheels, it’s probably good for his health—even if he’s not sure where he’s going. But that might not work so well for a state.
Take Missouri. Here, thanks to politicians, the Tea Party, and a commitment to values that date back to the founding of this great nation—or to at least three years ago—we’ve run as far as our wheel will take us against the Affordable Care Act, a.k.a. Obamacare, a.k.a. The End of Civilization as We Know It.
President Barack Obama signed the Affordable Care Act into law on March 23, 2010. It represented the largest overhaul of the nation’s healthcare system since 1965, when Medicare and Medicaid were established. Less than five months later, Missouri became the first state in the nation to throw down by referendum against the act—specifically, over one of its linchpins: an individual mandate to have health insurance.
“No law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system,” read the referendum. It passed with an overwhelming 71 percent of the vote.
“We’re excited and proud to be ground zero in the battle against this misbegotten federal healthcare reform,” proclaimed Lt. Gov. Peter Kinder. “We had the first vote in the nation in the Show-Me State. And we’re showing the nation the way to repeal and replace this big-government, big-bureaucracy, one-size-fits-all law.” Kinder also predicted the victory would help a lawsuit against Obamacare in which he was one of five plaintiffs. It didn’t.
Spin, spin, spin.
In 2011, the Missouri House of Representatives passed a bill to set up a state health-insurance exchange, only to have the state Senate reject it when it became known that the federal government would establish its own exchange by January 2014 for any state that failed to do so. So much for that passion for states’ rights.
That September, lawmakers insisted Missouri not spend a $21 million federal grant through Missouri Employers Mutual to lay the groundwork for a health-insurance exchange. The following February, the Missouri House Budget Committee rejected a $50 million federal grant to upgrade Medicaid computer systems. So much for state budget crises.
The U.S. Supreme Court upheld the constitutionality of most of the Affordable Care Act in June 2012, but it ruled that the federal government could not force states to expand Medicaid. Conservative Republicans in the legislature immediately announced they would turn down an $8.4 billion windfall over five years from the feds. Their “logic”: The state couldn’t afford to spend $431 million to get the money. So much for spending $5 to make $100.
Last November, Republicans succeeded in staging another show vote against the Affordable Care Act, this one called Proposition E. Placed on the ballot by the legislature, the measure forbade the governor to establish a health-insurance exchange by executive order (though he had shown no inclination to do so), and it contained legislation that prohibited state officials and departments from cooperating with a state or federal exchange. There was virtually no debate about the proposition, and no serious spending for or against it. As expected, it passed by a large margin (with 61 percent of the vote).
This year—even after Obama won his referendum at the ballot box—Missouri legislators made good on their pledge to walk away from federal Medicaid funds, despite testimony that the results would be devastating to some 260,000 Missourians, including the working poor in both rural and urban areas. Legislators also passed strict licensing restrictions (signed by Gov. Jay Nixon) that will stifle the use of “navigators” to help Missourians use the federal health-insurance exchange, which goes online this month.
Spin, spin, spin.
To be sure, Missouri isn’t alone in its opposition to the Affordable Care Act: Roughly half of the states have failed to expand Medicaid, and about the same proportion haven’t set up state-run exchanges. But no state’s been as vociferous as Missouri in attacking the act. As Kinder proudly noted, it’s second to none in this war.
But why? What’s this state have against healthcare reform? Why walk away from billions of dollars while facing a fiscal crisis?
Perhaps we just don’t like good health.
Let’s not forget that Missouri has another uncontested top ranking in the Unhealth Department: having by far the lowest tobacco taxes in America. At 17 cents per pack, that tax is barely more than half of the next lowest state and one-ninth of the national average.
Last year, voters turned down a 73-cent increase in tobacco taxes for the umpteenth time, presumably out of concern for the health of a relative handful of convenience stores near the state’s borders. Not that a state ranking 47th in education support and last in state workers’ pay should concern itself with a trifling $283 million annual influx of cash.
Some 25 percent of adult Missourians smoke, significantly higher than the national average of 20 percent. On the other hand, that only puts the state at ninth in the nation. So it wouldn’t be surprising if, as part of the anti–Affordable Care Act legislation, Republicans push for a pro-smoking campaign to rocket the state to the top.
Missouri is also in the top third in per-capita death rate (No. 14), shortest life expectancy (No. 13), percentage of children ages 10 to 17 who are overweight or obese (No. 17), and number of deaths per 100,000 caused by influenza and pneumonia (No. 15). Why should we possibly be concerned about healthcare?
To listen to Tea Party geniuses, it’s all about freedom. There’s the freedom to be denied insurance coverage because of a preexisting condition, the freedom not to have free preventive checkups, the freedom to be kicked off your parents’ health plan before age 26, the freedom to be misled by deceitful insurance information, the freedom to have more than 20 percent of your premiums spent on non-benefit-related activity, the freedom to have lifetime limits placed on your coverage, and the freedom to be driven to bankruptcy because of an accident and illness.
And to think: Obamacare has taken away all of those freedoms already, and it’s attempting to take away the sacred right of another 30 million Americans to be free of health insurance altogether. If that would happen, hospitals would be stripped of their freedom to subsidize unlimited numbers of nonpaying patients. Worst of all, with the dreaded mandate to purchase insurance coverage, it would aim to deny young, healthy, financially able men and women their sacred right to freeload on the healthcare system.
What’s next? Mandatory auto insurance? Where will this end?
Ah, but we’re told mandating auto insurance is a state function, which is an entirely different matter, because losing your liberty to state government is somehow not as repulsive as losing it to D.C. And why would that be?
Indeed, it wasn’t so long ago that some form of the dreaded insurance mandate was even acceptable to Republicans at the national level—as long as they were the ones advancing it in the name of personal responsibility. But the same concept coming from a liberal Democrat evokes imagery of jackbooted federal healthcare thugs.
If Democrats spoke the language of Republicans, they’d argue that providing first-rate healthcare is a great strategy for improving the gross domestic product, and thus the economy and strength of the nation. Healthy people are more productive than less healthy ones, and unhealthy people spread illness.
Let’s say you walk into a McDonald’s, and there are two checkout lines. One reads, “This cashier has had a health checkup this year.” The other reads, “This cashier has not had a health checkup this year.” Which line are you getting in?
Perhaps the most underrated aspect of healthcare reform is that all of us benefit in our daily lives—regardless of our background or our own insurance coverage—if the people with whom we come in contact are healthier. Free preventive medical care is a pillar of Obamacare that does just that.
But this does represent government regulation. There’s an inherent problem with the less-regulated “free-market” approach that Republicans claim is the answer: The insurance companies’ natural instincts to make a profit are directly at odds with the interests (and health) of their customers.
The companies’ basic business model is to serve people who need their resources the least. They have always profited by denying coverage to the riskiest customers and denying claims to the sickest.
Now, bring this up, and everyone this side of Mitt Romney says, “Oh sure. We have to do something about preexisting conditions.” But here’s a bipartisan fact: Until Barack Obama took office, nobody got that done.
Obamacare is no panacea—not even close. Might it result in some higher premiums or other costs for you and me? Perhaps. Insuring 30 million more people—or even nearly that amount—has got to cost somebody something. But it might be worth it.
We are interconnected in healthcare. For all of the things that divide Americans, good health should unite them. Even in Missouri.
Now if we could just get off that wheel.
SLM co-owner Ray Hartmann is a panelist on KETC Channel 9’s Donnybrook, which airs Thursdays at 7 p.m.
Commentary by Ray Hartmann
