The worst thing about the Cassidy-Graham amendment, Republicans’ 11th-hour attempt to repeal Obamacare, is that many millions of Americans would lose their coverage and see their premiums shoot up if they get sick. But only slightly less horrible is the incomparably dishonest way Senators Bill Cassidy and Lindsey Graham have been selling the proposal, which conflicts with a fundamental conservative tenet: that egalitarian policies “punish success.”
This is what you always hear from the right whenever anyone suggests taxing the wealthy even a little bit more. They respond that all Americans have the same opportunities to obtain wealth (they don’t) and we shouldn’t punish those who managed to thrive. It’s simply un-American to penalize those who put in hard work and play by the rules.
But the down-home pitch from Cassidy and Graham breaks with this entirely. They claim their plan instead strikes a blow for equality. “These funds are quite unequally distributed,” Cassidy told health-care reporters, referring to federal health-care spending issued to the states under the Affordable Care Act. “Where you live should not determine how healthy you are.” And here’s Graham on the Senate floor: “I like Massachusetts, Maryland, New York, and California, but I don’t like them that much to give them the money that the rest of us should get!”
Behind this touching concern for American welfare is a simple red-state-vs.-blue-state divide, perfectly timed for an age of polarization. Those Yankees are taking all our money, and we have to get it back. To get to this point, you have to ignore the fact that red states receive a disproportionate share of federal aid overall, and rank higher in terms of how much federal aid they take out relative to federal taxes they pay in.
But dig a hair deeper and you discover a simple fact: The states listed above obtained a disproportionate share of federal health-care dollars because they tried. Operating under the same terms available to every other state, they expanded the Medicaid program and did their best to sign up the uninsured for both Medicaid and the Obamacare exchanges. Instead of denying the poor coverage, they took the bargain offered under the ACA to cover all the costs of Medicaid expansion initially and around 90 percent over time. Instead of making it more difficult to navigate the individual market, or consign people to the federal exchange, these states built their own websites and worked to promote and assist with getting covered.