Wednesday, May 29, 2013

Lifting All Boats Is Still A Good Idea

Ta-Nehisi Coates has a good post up about the disproportionate effects that some states refusal to expand Medicaid as part of Obamacare are having on certain racial groups:
With that said, if you look at a map of which states are refusing the Medicaid expansion, and then look at this report from the Urban Institute, a troubling (if predictable) trend emerges. Approximately a fifth (about 18 percent) of all people who will remain untouched by the Medicaid expansion are black. When you start drilling down to the states where those black people tend to live, it gets worse. In Virginia and North Carolina, 30 percent of those who are going to miss out are black. In South Carolina and Georgia, the number is around 40 percent. In Louisiana and Mississippi, you are talking about 50 percent of those who would be eligible for the expansion but who will go uncovered.
You look at Latinos and get a similar (and to some extent worse) picture. Nationally, Latinos make up 18 percent of those who stand to get health coverage. But in Arizona -- where the legislature is fighting Jan Brewer's effort to expand Medicaid -- Latinos make up 34 percent of those who stand to gain coverage. In Florida, they make up 27 percent, and in Texas they make up 47 percent. Texas has the highest rate of uninsured in the country. The majority of people there who are going to miss out on care -- over 60 percent -- are black and Latino.
This is a great point and a good reminder that some GOP governors and state legislatures might be motivated by more than just a desire to protect "freedom."

The post unfortunately jumps the tracks when Coates argues that this setback shows that policies working to address the problems of all Americans are worse compared to those targeted at specific racial groups:
This is one reason why color-blind -- "lift all boats" -- policy so often falls short. When you have a country grappling with the deep vestiges of bigoted policy, you do not need "colored only" signs to get "colored mostly" effects. 

I think Coates is confusing cause and effect here.  What actually happened is the Supreme Court, in its infinite wisdom, decided to replace the system where states would have to expand access to Medicaid in order to keep their federal funds for the whole system of Medicaid, with a voluntary system in which states could opt out of expanding Medicaid but lose out on the large amounts of money that would come with expansion.  In short, a carrot and stick approach was turned into an all carrot approach and some GOP politicians decided not to opt for the carrot.

But these unfortunate side affect of a Supreme Court ruling is hardly the fault of "lift all boats" policies.  Indeed, Obamacare was changed from a "lift all boats" policy to an "ask GOP politicians to lift all boats" policy and the fact that some of them decided to say no is hardly the fault of Obamacare, it's their fault.  Giving all Americans access to health care is still a great idea, and doing it through broad based policies is still  a much better way to achieve political success that programs just targeted at certain racial groups.

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