[A version of this article is running in the newspapers in my conservative area of Virginia.]
As the American public recognizes, our political system has become dysfunctional. A big component of the problem is that disgraceful political conduct has become acceptable, and is often even rewarded. The rejection of Medicaid expansion by the Republicans in many states in which they have the power is a case in point.
That includes my own state of Virginia, where the Republicans in the General Assembly have steadfastly rejected Medicaid expansion. It is hard - perhaps impossible - to find a way that this rejection is good for Virginia for its people.
Many will not be swayed by the most obvious factor: that it leaves a couple of hundred thousand Virginians without the kind of health care security that every citizen gets in other advanced democracies. Some people will not be moved by the human cost of the failure to extend Medicaid, just as some applauded at a 2012 Republican presidential debate when one of the candidates said we should let the uninsured die.
But the rest of us Virginians are hurt, too.
First, there's the impact on the hospitals. A recent segment on the PBS News Hour compared two hospitals. One was in Washington state, where Medicaid expansion was passed, and where the additional resources have made it possible to expand services. To represent the alternative scenario, in states where Medicaid expansion was rejected, the News Hour chose a hospital in Virginia, the Winchester Medical Center. This hospital in Winchester, Virginia, the report said, has "laid off 28 people and is taking a hard look at [having to cut] costly services like its trauma center that treats people after car accidents and other serious injuries."
It isn't just poorer Virginians who pay a price. When people without coverage end up getting expensive crisis care, because they couldn't afford an ounce of prevention, the hospitals have to jack up the prices they charge everyone who does have coverage.
Then there's the blow to the Virginia economy more generally.
Virginians are paying billions of dollars in taxes that would be coming back to Virginia were it not for this rejection by Republicans. Virginians' tax dollars are helping people in other states while Virginians suffer. At the same time, the Virginia economy could be revitalized by the almost $4 billion that would be injected into the state if Medicaid were expanded.
So if the refusal to expand Medicaid is bad for Virginia, and bad for Virginians, why did the Republicans in the General Assembly make that choice? A look at how the Republican Party has dealt with health care reform nationally gives us the answer--for the case of Virginia, and for all the other states where Republicans have made the same injurious choice. At every turn, since the beginning in 2009, the Republicans have done what they could to block and then overturn and then sabotage the Affordable Care Act.
The Republicans' rejection of Medicaid expansion has to be seen as but one more piece in this six-year saga of sabotage.
That this saga represents disgraceful political conduct is not hard to demonstrate. And saying that the ACA (a.k.a. Obamacare) is a bad program does nothing to justify that conduct. That's because even if Obamacare were a bad program, the following three pieces together make an airtight case the case against the Republicans:
1. The United States had a huge problem with its health care system. Other countries get much more while spending less, so there was no doubt that a better system was possible. With trillions of dollars being wasted, and tens of thousands of American lives being lost, surely something had to be done.
2. Republicans have relentlessly assaulted the one solution proposed and passed.
3. One might attribute this assault to the defects of the solution (a solution that actually originated among Republicans) rather than to the determination to prevent Democrats from accomplishing anything, except for the third piece of the picture: Republicans did absolutely nothing to improve this health plan before it was enacted and have never proposed anything better.
To make war on the one solution out there while never proposing anything better is simply unacceptable. And, our founders would say, a violation of the spirit of the system of government they gave us.