Tuesday, March 25, 2014

ALEC Blocks Medicaid Expansion


Foolhardy though it may have been, I set a direction for this blog in 2014 by taking up (or should it be, “taking on?”) the priorities for policy and legislation, according to ALEC (American Legislative Exchange Council). I hoped to understand the recommendations and pieces of model legislation and to provide information for readers to evaluate.

As I read, re-read, and research each ALEC-identified priority as listed by The Center for Media and Democracy’s PR Watch, I struggled to explain complex issues using fewer than 1,500 words. Today’s topic, the Affordable (Health) Care Act is perhaps the most challenging of them all. So many words, in print and on air, have been devoted to this topic, and many of those words have been lies, distortions, and misstatements. Nevertheless, I accept one more challenge and will labor to make the complex comprehensible.

First, a few necessary facts…

The U. S. health care system was and still is in need of an overhaul because
  • We spend 2.5 times more per person than other developed nations.
  • We spend much more in all categories of care, especially for ambulatory care and overhead (administrative costs).
  • Even non-profit hospitals are profitable, in part because hospitals are, like banks and other corporations, merging and thereby creating behemoths against which insurers and patients have little protection. Furthermore, hospitals accept Medicare patients, and Medicare, in spite of complaints and negative narratives, pays well enough to cover the cost and provide some profit. Finally, even if hospitals only receive 35% of what they bill, they will profit from that amount.
  • We cannot expect to live as long as others in developed nations, in part because of our own unhealthy life choices, but also because of the state of health care.
  • And the U. S. health care system is not so much better that Canadians dash over the border for MRIs because the wait-time is too long in their own homes. This is a myth perpetrated by those who do not wish to change a for-profit health care system that excludes millions of Americans.
Second, two specific points about the Affordable Care Act, insurers, and ALEC.
  • Health insurance company representatives were at the table when the Affordable Care Act (ACA) was drafted. They are the reason for a health insurance requirement and fine if consumers choose to go without insurance. The companies’ interest was and is in having a large pool of payers of all ages to absorb the costs of high-risk groups since no one can now be denied insurance for having a pre-existing (and/or expensive) condition. This individual requirement was upheld by the Supreme Court.
  • Before the Supreme Court ruling, the ACA would have made health care available to millions more Americans through Medicaid expansion, but because of the court ruling, 19 states have opted out of the Medicaid expansion provision, and doing so is ALEC-inspired and ALEC-approved.  Indeed, ALEC has an array of resolutions and pieces of model legislation with the express intent of deregulating, decentralizing, and privatizing health care delivery in this nation. Helping ALEC achieve these aims are many pharmaceutical and health insurance companies.
Third, the question: why would ALEC--or anyone, for that matter--oppose Medicaid expansion.

One answer is ideological. Some believe that ours is rapidly becoming a nanny state (inevitably spoken with a derisive tone) consisting of individuals suckling at the government teat. Those believers fear that government should not step in where the free market should rule, that private entrepreneurs and risk-takers can, will, and should perform all services, and if we surrender those services to big government, we will weaken our nation.

Another answer is economic. Many believe that government can never afford to care for all of its citizens and the infrastructure and the common defense and so much more. Furthermore, these believers contend that government should not try to provide for so much because it will overburden citizens in the form of taxes, unnecessary record-keeping, and regulation.

A third answer lies in the federalism versus states’ rights debate that has been waged and rages on year after year. Some claim to believe that states should be supreme and the federal government subservient. Indeed, the Supreme Court seemed to agree by permitting states to opt out of a federal mandate when it weighed the merits and legitimacy of the ACA.

A fourth and final answer is the same one at the heart of all of ALEC’s proposals: capitalism and free markets willing and eager to move public dollars into private coffers. The origins of 401Ks, touted as putting individual money back under individual control instead of into state-run pensions and corporate retirement programs, had the net effect of impoverishing some and seriously undermining individual retirement dreams when Wall Street played with and lost those dollars. Deregulated banks manipulated products, bundled mortgages, and bamboozled regulators wearing blindfolds, so much so that people were forced out of homes at the same time that they lost their jobs while government bailed out those big, negligent spenders.

Let these two examples stand as sufficient evidence that hands in the pockets of citizens often empties them, and times they are not achangin’. More collapses, more downturns, more crises are on the horizon--not as the result of government overreach, but as a result of government agreeing to accept a hands-off mandate. Regulation has proved to serve the nation’s interests very well.

Fourth, Refusing to Expand Medicaid Undermines the ACA and Hurts Citizens

ALEC’s resolutions and pieces of model legislation related to health care effectively blocked the social safety net and consumer protections that the bill could have, might have delivered. According to Wendell Potter, a former health care industry insider and ALEC attendee, ALEC has succeeded with four of its five goals. These are:
  • “Keeping single-payer proposals off the table;
  • Ensuring that the final bill contain a clause requiring all Americans not eligible for an existing federal program to buy coverage from a private insurance company;
  • Preventing the new law from establishing a government-run plan (the 'public option') that would compete with private insurers; [and]
  • Making sure that the reform law is implemented primarily at the state level, to keep the federal government from assuming any significant new oversight of private insurers’ business practices.”
Achieving these aims has the net effect of discriminating disproportionately against minority and poor people.  In other words, the first health care reform offered in more than three decades with funding mechanisms attached will not remedy the health care crisis for approximately 5.4 million Americans. Instead ALEC and its pharmaceutical and health care members continue to fight for every dollar in profit even though the bill was designed to secure profit for them.


When the aim is to insure profit at the expense of human life and quality of life, then the aim must be redirected. We need altruism so that all citizens have equal opportunities to life, liberty, and the pursuit of happiness.