Over the weekend I wrote about the upside of the wingnut-controlled state legislature’s dabbling in the timeless art of Political Kabuki by refusing to set up the health insurance exchanges – namely that they are squandering their opportunity to screw it up by leaving it up to the Department of Health and Human Services. I trust any three random civil servants far more than I trust Brian Silvey, Tim Jones and, oh, let’s say Wanda “seatbelts=tyranny” Brown. (I’ve always wondered if her insurance company ever got around to comparing her public record with her accident report before they paid out on her claim after she was seriously – needlessly, even – injured in a car crash.)
But that post drew a comment that got me to thinking. Willy K, my colleague here at SMP agreed that it’s probably for the best if the jackasses in the GOP-controlled lege leave it to the feds, because they’re too inept to organize a two-horse parade, let alone set up a health insurance exchange, but she is concerned about the indications that they will resist the Medicaid expansion that is the part of the ACA that the Supreme Court did find unconstitutional and strike down.
That comment got me to thinking, and when I start thinking, I start asking questions. And when I start asking questions, I go looking for answers. Not easy ones, and not ones that I want to hear, but the ones that are factual.
And since I decided to go to law school, I have added another dimension to the questions I ask and answers I seek. . .Now, I look for precedent.
And when I went looking for precedent, I started by looking at history and state statutes.
And what I found made me roll my eyes.
If you think that you’ve seen this movie or heard this tune before, you are correct. When Medicaid was authorized in 1966, it got a cool reception and there was resistance to implementing it. It took the rural areas a while to realize that the same things that help “those people” in big, scary St. Louis and crime-infested Kansas City would help them, too. It was the nursing home care for the elderly that swung popular opinion in the northern tier where I come from.
In late 1967, approximately two years after the federal legislation authorizing Medicaid was passed and signed into law by Lyndon Johnson, the 74th General Assembly got on board and passed legislation that authorized the Missouri Medicaid Program under Title XIX of the Social Security Act.
History repeated itself a generation later. The federal Childrens Health Insurance Program was passed and signed into law a generation later by President Bill Clinton in 1996. MC+ for Kids went into effect two years later – on September 1, 1998.
Seeing a pattern developing here? This isn’t the first time we’ve heard this song, and it isn’t the first time we’ve danced to it.
The republicans in the lege are making a lot of noise. That’s what they do. They bluster and blow and preen and strut and generally make complete and utter asses of themselves, then after they have their wingnut cred firmly established with the “base” back home – and since I was a child the republican “base” has changed. It used to be pragmatic businessmen who owned the businesses that were around the town square. Now it’s religious freaks and crazy people who have a view of reality that is so warped that they believe that if I decline to join them for bible study and in the singing of Hosannas to their Lord, well, I’m a persecuting oppressor or an oppressing persecutor or something.
So they will make their noise and cement their status as just-as-crazy-as-thou and then, quietly, a couple of years down the road, they will without much fanfare come to the conclusion that the math works in our favor and they will implement the expansion, with a no-death-panels proviso, of course.
That’s the thing about crazy people – in general, they’re pretty predictable. And once Medicaid is expanded, a whole bunch more of them will be able to get treatment.