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When Politics Trumps Policy Implementation

By Mariam H. Jalloul

The current government shutdown is a result of Congress’s inability to pass a spending bill. More specifically, it is a result of the Republican-majority House of Representatives demanding that the spending bill defund or delay the Affordable Care Act and the Democratic-majority Senate’s unsurprising refusal to agree to these terms. This is a showcase of how political ideology is currently trumping policy implementation in Washington. The Supreme Court declared the ACA constitutional, and its implementation as law has already begun. Unable to accept this fact, Republicans have used every chance to push back. In addition to refusing to fund important government services, they have jumped at the opportunity to use the portion of the Supreme Court’s decision that declared Medicaid expansion unconstitutional to fight against this law, a tragic bit of political theatre that will broaden the very population of uninsured Americans that the ACA hoped to shrink.

One of the ACA’s main provisions is the expansion of state Medicaid eligibility, which allows a greater number of people to receive this government aid. Another key feature is the Health Insurance Marketplace, better known as the state-run health insurance exchange, which opened for enrollment on October 1, the first day of the government shutdown. It allows people who are 100 to 400 percent above the Federal Poverty Level to compare private health plans and buy affordable, fitting health coverage. These two provisions work together quite well for individuals below the FPL and thus ineligible for the exchanges, for they would be covered through the expanded Medicaid. This helps achieve the ACA’s main goals: reducing the number of uninsured Americans, making health care nearly universal, and making it affordable.

However, the Supreme Court’s decision about the constitutionality of the Medicaid expansion allowed some Republican states to use this decision as a tool to hurt their tax-paying citizens. The ACA’s Medicaid expansion initially dictated every state to expand its Medicaid coverage or completely lose its existing federal funding for the program.  The court ruled that it was “unconstitutionally coercive”—therefore, Medicaid expansion would still be an option for states that wish to expand, but expansion is no longer mandatory. As a result, 16 governors oppose expansion and 26 states currently do not have plans to expand their Medicaid coverage.

As a result, individuals who fall under 100 percent of the FPL are unable to receive subsidies in the exchange market, and if those people live in states that are not expanding Medicaid, they will not be able to receive Medicaid either—as of now, only people at or below 138 percent of the FPL are eligible. In what was supposed to be a policy implementation that would expand coverage, Republican governors are using their state rights to fight against the policy, disregarding their disadvantaged citizens who would need the expansion in order to qualify. As a result, these states have created a pool of poor people who will continue to be uninsured simply because their state refused to expand Medicaid.

Since the federal government is covering 100 percent of the expansion for the first five years of implementation, the monetary aspect of the expansion is not an issue for a majority of the states. In fact, it is strategically unwise for a state not to expand its Medicaid, for its citizens will not receive the benefits for which their taxes are paying. In a fight of political ideology, these states are perpetuating their citizens’ ill access to health insurance out of spite for a law with which they disagree.

This point is reinforced by some states that refuse to even administer the health care exchanges, which are also fully funded by the federal government. Some states, such as Florida, are putting in extensive effort to stop their citizens from receiving cheap health insurance from the exchanges, going as far as barring specially trained outreach counselors from assisting people. Thankfully, the federal government has the power to and will administer them in the states that will not offer them. This does not excuse the irrationality of refusing to allow your citizens access to health insurance.

While the Republicans are under heat for causing the government shutdown and fruitlessly attempting to repeal the ACA a whopping 42 times, a critical issue that has received little attention is Republican governors’ neglect for disadvantaged individuals who would benefit from Medicaid expansion. Even though these people will be exempt from the individual mandate because they will be unable to afford private insurance, it is unfortunate that the political stances’ of their home states will deny them access to quality health care. Although the court ruled justly in stating the federal government cannot coerce a state to implement a policy, it is economically unwise and morally corrupt to refuse to expand Medicaid to the citizens who need it the most.

Mariam H. Jalloul ’16 is a Crimson editorial writer in Mather House.

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