We Are Still Fighting the Civil War Over Health Care for the Working Poor

By BOB HERTZ

The Affordable Care Act of 2009 required all states to expand Medicaid for the working poor. The federal government would pay all the costs of expansion for three years, and 90% of the cost thereafter.

However, the expansion became voluntary after a lawsuit in 2012…..and eleven Southern states have still refused to participate. Over three million poor residents of those states have no health insurance, and chronically high medical debt.

This kind of refusal is nothing new; it is part of a long-running conflict. The issue is technically called Federalism - though I think that term is too polite. ‘Federalism’ has often provided intellectual cover for bigotry and cruelty.

It is essentially the same struggle every time. The basic conflict has not changed since the Civil War.

The federal government – often staffed by liberals, women, and minorities – creates high-spending, color-blind programs, aimed mainly at the poor.

But in the former slave states, the programs are opposed by fiscally-cautious, racist legislatures.

In the 1930’s, federal bureaucrats had to push local officials to actually implement the WPA and food relief. (see The Hungry Years, by T. H. Watkins)

After World War II, Southern politicians tried to prevent black veterans from voting. For years, the Southern delegation prevented a basic anti-lynching law.

Federal labor laws were bitterly resisted in the South – because they threatened the profits from cheap black farm labor and cheap white factory labor. Convict labor was also prevalent, as a partial replacement for slavery. (see Fear Itself, by Ira Katznelson)

In the 1950’s and 1960’s, the violent resistance to Civil rights laws is well documented. The long struggle to preserve discrimination showed that states cannot be trusted on all dimensions of public policy.

Southern legislators initially opposed Medicare – because it would integrate their hospitals. “Keeping black people out of white hospitals was more important to Southern politicians than providing poor whites with the means to get medical treatment,” Paul Krugman wrote.

Even today, HIV cases are now concentrated in Southern states where progress against the disease has slowed. More than half (52%) of all new HIV diagnoses in 2017 were in the South.

Bottom line: many Southern Whites do not like to pay for public goods – such as health care — which they consider to be transfers to Americans of darker complexion. They want poor people to basically get out of town, so that their states will be more attractive to wealthy White retirees. They want freedom, all right – the freedom to lord it over others.

Bill Maher once said that “The real job of liberal northerners is to bring the hillbilly states into the 21st century.” To me that is the real debate about “Federalism.”

Bob Hertz is a retired insurance broker in Minnesota and author of “Social Insurance vs. Medical Darwinism.” He blogs at The Anti-Debt Agenda.com

From The Progressive Populist, May 1, 2023

Populist.com