Ezra Klein, despite my pleas to the TV gods, was once again filling in for Rachel Maddow last night. He began the show with an informative and detailed segment concerning the one part of the healthcare law that SCOTUS zapped last week; the Medicaid expansion. As stands right now before the law takes effect, states and the federal government share in the cost to cover medical spending for poor people. Obamacare (as it was originally designed) included a pretty significant increase in the federal contribution for the cost of covering those people (from 57% to 100% for some time and then down to 90%) in exchange for states actively seeking to cover 100% of their residents with at least some form of health insurance.
This policy solution was supposed to solve the problem where states like Texas would design their own Medicaid programs to where only the most destitute people would be eligibile (thus saving the state some money upfront). The law also included a massive penalty where the federal government would remove all federal medicare spending if this “full coverage” goal was not pursued or accomplished. The court struck down that penalty as an example of the federal government exerting unconstitutional power over the states.
So while that part of the ACA decision was questionable, the fact remains that there is still a huge incentive for states to to take the federal money. Red states (whose leaders have never been too keen on making life better for poor folks) are in a very advantageous position as they stand to inherit the most money out of this deal. Klein, after demonstrating the fact that states like Texas would be turning down literally billions of dollars, was sure that southern governors would be lining up to accept this gift. Howard Dean, Klein’s guest, went on to state that since all sectors of a state economy stood to benefit from this program no rational person would actually advocate for rejecting it.
All of these people who are predicting the south to be convinced by this line of thinking are wrong. Klein and Dean are exactly right in terms of the substance of what the law will do for the states, but they are completely off in their basic assessment of southern politics. The south will fight this thing to the end, even if it makes no fucking sense, because that is what the south does.
My basic theory as to why the south will take the lead in this “mass resistance” for keeping poor people without health insurance can be summed up in this picture:
This picture is an example of what the federal government had to do to ensure that black school children could safely attend a public school in Arkansas after the Supreme Court declared that segregation was unconstitutional. I can say as someone who has lived half of my life as a southerner that that region of the country is lead by and represented by some of the most malignantly evil motherfuckers that you could possibly imagine. It is a region where politics is really just a miasma of racial and class discontent that business interests stir whenever it suits their short term needs. Keeping black and white poor people trapped in the bonds of ill health has been and always will be a necessity for the powerful people in the south to remain unchallenged in their ability to influence policy and keep economic opportunity as stagnant as possible.
Literally whenever the federal government has decided that it is tired of subsidizing the feudal southern economy and its nepotistic aristocracy the south has responded like a petulant child (only one with access to firearms). Whether it be slavery, desegregation, or access to basic utilities, the powers that be in the south have resisted at every single step. People like Klein or Dean need to know that logic and reason simply do not apply in a place where racial and class based politics define every single aspect of society. There are only two ways for progressive outsiders to “win” in the south; ignore the local politics and supply federal assistance directly to the massive populations of poor people that live in the area, or march the motherfuckers into the sea.
Note: The original draft of this post referred to Medicaid as Medicare (the old people government health insurance). I apologize for hurting your brains with that dumbass mistake.