There is some evidence that at the national level the Republican Party has started to grasp the reality of a new electoral majority – composed of ethnic minorities, youth, women who vote on women’s issues, and gays – that endangers their party if they do not come out of their ideological echo chamber and change their policy stands so that they benefit more people. A last gasp of the GOP as the party of Rush Limbaugh could be heard in Mitt Romney’s pathetic explanation of his loss to President Obama: namely, that Obama had “bribed” various constituencies by giving them all something they wanted. Of course, if you take this insult out of the realm of unsubstantiated paranoia, all Romney was saying was that more people voted for Obama than Romney because more people stood to benefit from his policy stands. To which can only be said: Exactly.
In Missouri, it’s difficult to believe that a GOP puffed up by its false supermajorities in the Legislature (despite the fact that it holds fewer statewide offices than Democrats) will follow its national leadership and come back down to earth where real people live and vote. We see a hopeful sign in Gov. Jay Nixon, a very conservative Democrat, coming out in full support of Medicaid expansion in Missouri. Nixon is hated and targeted by the Republican political class in Missouri, but many people who tend to vote Republican must be voting for Nixon, looking at his numbers; he beat his Republican challenger in November by 330,000 votes with 55 percent of the vote. As such, Nixon is a good bellwether for how far to the left Missouri is likely to lean on anything, and even in his last term Nixon would likely not make this stand if he did not anticipate public support for it.
And why not? Despite every assault from Republicans imaginable, Obama’s signature Affordable Care Act (ACA) is the law and it is going to be implemented. Under the ACA, the federal government will fund 100 percent of Medicaid expansion from 2014 to 2016. After that, Missouri will gradually pick up a share of the cost until it funds 10 percent of the expansion by 2020. The U.S. Supreme Court decision made expansion optional, meaning that states like Missouri could opt out – but only by costing themselves $8.2 billion in federal contributions to Missouri Medicaid during 2014-2020, money paid by Missourians that would instead go to expand other states’ Medicaid programs. Nixon is asking Missouri to expand access to health services for an estimated 300,000 low-income people (which appeals to progressives) while bringing federal money to the state (which should appeal even to conservatives, once they step out of their echo chamber).
Specifically, Nixon said he supports expanding eligibility for Medicaid to those earning up to 138 percent of the federal poverty level. That would mean a family of three making $25,400 a year, or an individual earning $14,000, would be eligible for the program. That is a good policy stand, and whatever self-serving politics may be behind it for a term-limited governor with expected national aspirations, we commend him for making this decisive stand at the outset of his final term.
It also is a sound, farsighted fiscal policy stand. The alternative, said Steven Lipstein – head of BJC, the St. Louis area’s largest employer – is to continue to shift costs of attending to the poor in emergency rooms to the middle class. “If the Legislature does decide not to expand the Medicaid program and hundreds of thousands of Missourians continue to be uninsured, we will continue to shift that cost of care to all the commercial insurance premium payers here in the state of Missouri,” Lipstein said – “instead of the cost being borne by the federal government as the governor outlined in his remarks today.” Expanding Medicaid also will generate 24,000 more jobs, increase payroll by nearly $7 billion and boost state and local tax revenue by $856 million between 2014 and 2020, according to a new report (see Business, B1).
Republicans nationally are doomed – as they are beginning to realize – if they continue to despise the role of federal government and “entitlement programs” so much that they fight to defeat them at all costs. As the soon to be infamous Grover Norquist once said, he wants a federal government so small it can be drowned in a bathtub. We implore Missouri Republicans to realize they are losing the war of ideas, and it is time to grasp that reality and pass some policy stands that benefit actual people, rather than flattering your own fantasies of a government so small you can drown it.
