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The high cost of the Missouri GOP's Obamacare tantrum

Missouri GOP legislators are determined to continue the tantrums they began throwing when Obamacare, the promised healthcare reform that helped get President Obama elected in 2008, was enacted. Most recently they have been stamping their little feet and declaring that Missouri will expand Medicaid over their dead and inert bodies (not to mention their inert minds). As Springfield Missouri resident Jan Lancaster lamented after attending a townhall meeting with several Republican legislators:

The meetings were not to gather input but rather to justify a "no" vote. No one was fooled. Missouri's Medicaid program will stay a national embarrassment with a loss of $8 billion to the state over the next three years. (Missouri is in the bottom three or four when it comes to Medicaid assistance nationwide.)

Five out of six of the representatives present indicated that they had already decided to vote "no." The only thing they did not do was link arms behind the table that they placed between them and us.

And make no mistake - GOP opposition to expanding Medicaid eligibility is no more than the spite of a bunch of frustrated bullies who are willing to cut off their noses, as Ezra Klein quipped, to spite Obama. They certainly reap no advantage from their opposition:

The survey of registered voters, by the Republican polling firm American Viewpoint Inc. of Alexandria, Va., found that Missourians overall support expanding Medicaid limits, as called for in the federal Affordable Care Act. After hearing a "balanced set" of arguments for and against the proposal, 56 percent favored expansion and 35 percent opposed it.

Pollsters found that Democratic Gov. Jay Nixon, who favors the expansion, is regarded much more favorably by voters than Republicans in the legislature, who present the obstacle.

Opposing an expansion, the pollsters warned, could "drive down the GOP brand further with swing voters." Independent women voters were strongly supportive of expanding Medicaid limits.

Nor are their "principled conservative" arguments for opposing the expansion convincing. They tend to hinge on purely speculative "what ifs" that are supported by little or no objective evidence (e.g., the federal government won't carry out its end of the funding agreement), disproven (it will be too expensive for the state or it will add to the federal deficit), along with other desperately grasped at straws. However, as many have argued (see here, here (pdf), here, and here (pdf)), expanding Medicaid will boost the entire Missouri economy while the opposite will have a correspondingly negative effect.

And finally, not to ignore the gorilla in the room, GOP intransigence on this topic will hurt many, many low income Missourians. Take a look at the map below (from a report in the New England Journal of Medicine via ThinkProgress) that shows how Missouri counties stack up relative to counties in other states in terms of individuals ineligible for Medicaid who delay medical care because they cannot afford it:

While Missouri doesn't look as bad as Texas and Florida, the two worst offenders, it's pretty dark pink - more like the Southern states that tend to limit Medicare eligibility than those states that have already expanded eligibility. In eight Missouri Counties, 19.8%-40.6% of the population have fallen between the healthcare cracks and report having to forego medical care. Seventeen counties have 17.2%- 19.7% of their citizens in that situation, for another seventeen counties the number is 15.4%-17.1%. Check it out yourself on this easy to enlarge version of the map.

Recently Minnesota GOP Rep. Michele Bachmann garnered lots of the attention she seems to crave by declaring that Obamacare would "literally kill" people - no more than silly rhetorical overkill, or, perhaps, given the source, real ignorance. However, no matter how I strive to avoid hyperbole, the evidence leaves me thinking that the GOP's anti-Obamacare tantrum really does have the potential to lead to many preventable deaths. Further, it's harder to conclude that they even care about such a result, when their overriding concern seems to be their horror of some fantastical concept of "government dependency" that justifies leaving the most vulnerable helpless.

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