Commentary Abortion

Is Sadism the Driving Force Behind GOP Rejection of Medicaid Expansion?

Amanda Marcotte

There's no reason to reject the Medicaid expansion except pure hatred for lower-income Americans. It doesn't save money; to the contrary, it costs taxpayers more not to expand Medicaid.

Despite a lot of posturing and complaining, the Republican opponents of the Affordable Care Act (ACA) are relatively limited in what they can do to prevent implementation of Obamacare. Sadly, however, there is one aspect of the law that Republicans at the state level have demonstrated that they’re eager to fight back against, and—no big surprise—it’s the one that affects some of the most financially needy Americans: Medicaid expansion. The Supreme Court ruled last year that the provision—which would require states to expand Medicaid to cover people up to 133 percent of the poverty line—is optional, and so far 21 states have decided to opt out.

The result, according to ThinkProgress’ Sy Mukherjee, will be devastating. Mukherjee reports on a new study by the Commonwealth Fund, which shows that these Medicaid expansion refusals could result in up to 42 percent of the people living in those states who went uninsured at some point in the past two years being left out of Obamacare. As the unemployment rate continues to hover above 7 percent, the chance that this giant hole in coverage will somehow resolve itself through employment for the poorest Americans seems like a long-off fantasy.

Make no mistake: The only reason Republican-led states are doing this is out of an ideological distrust often bordering on hatred of the working class. According to the relentless drumbeat of conservative media outlets like Fox News, people who require government help to survive are just lazy leeches who think they’re too good to fight for a better-paying job. But the second that the lowest-income Americans do stand up for themselves and demand better pay so that they don’t have to go on Medicaid and food stamps, the very same conservatives angrily denounce them for that too. You’re a bad person if you need help. You’re a bad person if you seek a job with a living wage. Given the conservative mentality, there’s nothing people can do to win.

The refusal to accept the Medicaid expansion cannot be justified through the usual half-baked conservatives rationalizations. It doesn’t save the states any money to refuse it; the expansion is to be paid for almost entirely by the federal government. In other words, taxpayers in those states will pay the same taxes as everyone else, but their states will get less in return. That means it is costing the states money to refuse the Medicaid expansion. And that’s all before the excessive health costs that end up falling on taxpayers when people who don’t have insurance end up in emergency rooms, often because they couldn’t afford preventive care. In addition, refusing the Medicaid expansion reduces the amount of competition on the insurance market, meaning that even well-off Americans in red states will be paying more for insurance.

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In other words, given a choice between saving their states and their taxpayers money and deliberately forcing lower-income Americans to go without health care, most Republican state governments have chosen the latter. (Though not all—Arizona, New Jersey, Iowa, and North Dakota all have Republican governors who decided they want a better-run state more than they want to stick it to the poor.)

Women are going to be badly affected by this petulant screw-the-poor grandstanding on the part of Republican state legislators and governors. This January, the American College of Obstetricians and Gynecologists issued a press release pointing out that 19 million women are uninsured and that the Medicaid expansion could change that. Because of the holes in insurance coverage in the current system, there’s a much higher incidence of bad outcomes with sexual and reproductive health than there should be. Some direct statistics quoted from the press release:

Uninsured pregnant women receive fewer prenatal care services than insured women and are more likely to experience adverse maternal outcomes such as pregnancy-related hypertension and placental abruption. Adverse outcomes, such as low birth weight and infant mortality, also are more common among uninsured women. Improved maternal and fetal outcomes occur with access to high-risk pregnancy care, counseling, and other enabling services. … Inadequately addressing pregnancy complications may have disastrous long-term emotional and economic effects on families. Society may face unintended increased costs to provide medical services to care for children born to uninsured women who have pregnancy complications.

Uninsured women are less likely than insured women to use prescription contraceptives, partly accounting for adverse reproductive health outcomes, including elevated rates of unintended pregnancy and abortion in poor women …

Uninsured women with breast cancer are 30–50% more likely to die from cancer or cancer complications than insured women with breast cancer …

Uninsured women are 60% more likely than insured women to receive a diagnosis of late-stage cervical cancer.

One of the ACA’s great benefits to women of reproductive age is access to birth control without a co-pay. While contraceptive use was already improving in the population writ large—particularly among teens—lower-income women still have serious problems preventing unintended pregnancies, in no small part because paying out-of-pocket for contraception is often out of reach. Pills sometimes have to be skipped because you can’t afford them this month, and while condoms may seem cheap to middle-class Americans, a box of them at the drugstore costs as much as what is supposed to be three days worth of food on food stamps. When you’re living so close to the edge, being able to scrounge up enough for contraception is a touch-and-go thing, which is no doubt why unintended pregnancy rates are going up for lower-income women even as they go down for everyone else.

With one swift, cost-effective move beneficial to both taxpayers and public health alike—embracing the Medicaid expansion—Republican governors can help close the health-care gap between low-income Americans and everyone else, a gap that currently contributes to more unwanted pregnancies and more abortions. They must stop posturing to win the accolades of right-wing media who enjoy the idea of starving out the poor for the simple sadistic pleasure of doing so.

News Politics

Tim Kaine Clarifies Position on Federal Funding for Abortion, Is ‘for the Hyde Amendment’

Ally Boguhn

The Democratic Party voiced its support for rolling back the restriction on federal funding for abortion care in its platform, which was voted through this week.

Sen. Tim Kaine (D-VA), Hillary Clinton’s running mate, clarified during an interview with CNN on Friday that he still supports the Hyde Amendment’s ban on federal funding for abortion care.

During Kaine’s appearance on New Day, host Alisyn Camerota asked the Democrat’s vice presidential nominee whether he was “for or against” the ban on funding for abortion. Kaine replied that he had “been for the Hyde Amendment,” adding “I haven’t changed my position on that.”

Robby Mook, Clinton’s campaign manager, told CNN on Sunday that Kaine had “said that he will stand with Secretary Clinton to defend a woman’s right to choose, to repeal the Hyde amendment.” Another Clinton spokesperson later clarified to the network that Kaine’s commitment had been “made privately.”

The Democratic Party voiced its support for rolling back the restriction on federal funding for abortion care in its platform, which was voted through this week.

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“We will continue to oppose—and seek to overturn—federal and state laws and policies that impede a woman’s access to abortion, including by repealing the Hyde Amendment,” reads the platform.

Kaine this month told the Weekly Standard that he was not aware that the party had put language outlining support for repealing Hyde into the platform, noting that he had “traditionally been a supporter of the Hyde amendment.”

Clinton has repeatedly said that she supports Hyde’s repeal, calling the abortion care restriction “hard to justify.”

Abortion rights advocates say that Hyde presents a major obstacle to abortion access in the United States.

“The Hyde amendment is a violent piece of legislation that keeps anyone on Medicaid from accessing healthcare and denies them full control over their lives,” Yamani Hernandez, executive director of the National Network of Abortion Funds, said in a statement. “Whether or not folks believe in the broken U.S. political system, we are all impacted by the policies that it produces. … Abortion access issues go well beyond insurance and the ability to pay, but removing the Hyde Amendment will take us light years closer to where we need to be.”

News Politics

Anti-Choice Democrats: ‘Open the Big Tent’ for Us

Christine Grimaldi & Ally Boguhn

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

Read more of our coverage of the Democratic National Convention here.

Democrats for Life of America gathered Wednesday in Philadelphia during the party’s convention to honor Louisiana Gov. John Bel Edwards (D) for his anti-choice viewpoints, and to strategize ways to incorporate their policies into the party.

The group attributed Democratic losses at the state and federal level to the party’s increasing embrace of pro-choice politics. The best way for Democrats to reclaim seats in state houses, governors’ offices, and the U.S. Congress, they charged, is to “open the big tent” to candidates who oppose legal abortion care.

“Make room for pro-life Democrats and invite pro-life, progressive independents back to the party to focus on the right to parent and ways to help women in crisis or unplanned pregnancies have more choices than abortion,” the group said in a report unveiled to allies at the event, including Democratic National Convention (DNC) delegates and the press.

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Democrats for Life of America members repeatedly attempted to distance themselves from Republicans, reiterating their support for policies such as Medicaid expansion and paid maternity leave, which they believe could convince people to carry their pregnancies to term.

Their strategy, however, could have been lifted directly from conservatives’ anti-choice playbook.

The group relies, in part, on data from Marist, a group associated with anti-choice polling, to suggest that many in the party side with them on abortion rights. Executive Director Kristen Day could not explain to Rewire why the group supports a 20-week abortion ban, while Janet Robert, president of the group’s board of directors, trotted out scientifically false claims about fetal pain

Day told Rewire that she is working with pro-choice Democrats, including Sen. Kirsten Gillibrand and Rep. Rosa DeLauro, both from New York, on paid maternity leave. Day said she met with DeLauro the day before the group’s event.

Day identifies with Democrats despite a platform that for the first time embraces the repeal of restrictions for federal funding of abortion care. 

“Those are my people,” she said.

Day claimed to have been “kicked out of the pro-life movement” for supporting the Affordable Care Act. She said Democrats for Life of America is “not opposed to contraception,” though the group filed an amicus brief in U.S. Supreme Court cases on contraception. 

Democrats for Life of America says it has important allies in the U.S. House of Representatives and the U.S. Senate. Sens. Joe Donnelly (IN), Joe Manchin (WV), and Rep. Dan Lipinski (IL), along with former Rep. Bart Stupak (MI), serve on the group’s board of advisors, according to literature distributed at the convention.

Another alleged ally, Sen. Bob Casey (D-PA), came up during Edwards’ speech. Edwards said he had discussed the award, named for Casey’s father, former Pennsylvania Gov. Robert P. Casey, the defendant in the landmark Supreme Court decision, Planned Parenthood v. Casey, which opened up a flood of state-level abortions restrictions as long as those anti-choice policies did not represent an “undue burden.”

“Last night I happened to have the opportunity to speak to Sen. Bob Casey, and I told him … I was in Philadelphia, receiving this award today named after his father,” Edwards said.

The Louisiana governor added that though it may not seem it, there are many more anti-choice Democrats like the two of them who aren’t comfortable coming forward about their views.

“I’m telling you there are many more people out there like us than you might imagine,” Edwards said. “But sometimes it’s easier for those folks who feel like we do on these issues to remain silent because they’re not going to  be questioned, and they’re not going to be receiving any criticism.”

During his speech, Edwards touted the way he has put his views as an anti-choice Democrat into practice in his home state. “I am a proud Democrat, and I am also very proudly pro-life,” Edwards told the small gathering.

Citing his support for Medicaid expansion in Louisiana—which went into effect July 1—Edwards claimed he had run on an otherwise “progressive” platform except for when it came to abortion rights, adding that his policies demonstrate that “there is a difference between being anti-abortion and being pro-life.”

Edwards later made clear that he was disappointed with news that Emily’s List President Stephanie Schriock, whose organization works to elect pro-choice women to office, was being considered to fill the position of party chair in light of Rep. Debbie Wasserman Schultz’s resignation.

“It wouldn’t” help elect anti-choice politicians to office, said Edwards when asked about it by a reporter. “I don’t want to be overly critical, I don’t know the person, I just know that the signal that would send to the country—and to Democrats such as myself—would just be another step in the opposite direction of being a big tent party [on abortion].” 

Edwards made no secret of his anti-choice viewpoints during his run for governor in 2015. While on the campaign trail, he released a 30-second ad highlighting his wife’s decision not to terminate her pregnancy after a doctor told the couple their daughter would have spina bifida.

He received a 100 percent rating from anti-choice organization Louisiana Right to Life while running for governor, based off a scorecard asking him questions such as, “Do you support the reversal of Roe v. Wade?”

Though the Democratic Party platform and nominee have voiced the party’s support for abortion rights, Edwards has forged ahead with signing numerous pieces of anti-choice legislation into law, including a ban on the commonly used dilation and evacuation (D and E) procedure, and an extension of the state’s abortion care waiting period from 24 hours to 72 hours.