Something
terrible has happened to pregnant women in Texas: their mortality rate
has doubled in recent years, and is now comparable to rates in places
like Russia or Ukraine. Although researchers into this disaster are
careful to say that it can’t be attributed to any one cause, the death
surge does coincide
with the state’s defunding of Planned Parenthood, which led to the
closing of many clinics. And all of this should be seen against the
general background of Texas policy, which is extremely hostile toward
anything that helps low-income residents.
There’s
an important civics lesson here. While many people are focused on
national politics, with reason — one sociopath in the White House can
ruin your whole day — many crucial decisions are taken at the state and
local levels. If the people we elect to these offices are irresponsible,
cruel, or both, they can do a lot of damage.
This
is especially true when it comes to health care. Even before the
Affordable Care Act went into effect, there was wide variation in state
policies, especially toward the poor and near-poor. Medicaid has always
been a joint federal-state program, in which states have considerable
leeway about whom to cover. States with consistently conservative
governments generally offered benefits
to as few people as the law allowed, sometimes only to adults with
children in truly dire poverty. States with more liberal governments
extended benefits much more widely. These policy differences were one
main reason for a huge divergence in the percentage of the population
without insurance, with Texas consistently coming in first in that
dismal ranking.
And
the gaps have only grown wider since Obamacare went into effect, for
two reasons. First, the Supreme Court made the federally-funded
expansion of Medicaid, a crucial part of the reform, optional at the
state level. This should be a no-brainer: If Washington is willing to
provide health insurance to many of your state’s residents — and in so
doing pump dollars into your state’s economy — why wouldn’t you say yes?
But 19 states, Texas among them, are still refusing free money, denying health care to millions.
Beyond
this is the question of whether states are trying to make health reform
succeed. California — where Democrats are firmly in control, thanks to
the GOP’s alienation of minority voters — shows how it’s supposed to
work: The state established its own health exchange,
carefully promoting and regulating competition, and engaged in outreach
to inform the public and encourage enrollment. The result has been
dramatic success in holding down costs and reducing the number of
uninsured.
Needless
to say, nothing like this has happened in red states. And while the
number of uninsured has declined even in these states, thanks to the
federal exchanges, the gap between red and blue states has widened.
But why are states like Texas so dead-set against helping the unfortunate, even if the feds are willing to pick up the tab?
You
still hear claims that it’s all about economics, that small government
and free markets are the key to prosperity. And it’s true that Texas has
long led the nation in employment growth. But there are other reasons
for that growth, especially energy and cheap housing.
And we’ve lately seen strong evidence from the states that refutes this small-government ideology. On one side, there’s the Kansas experiment
— the governor’s own term for it — in which sharp tax cuts were
supposed to cause dramatic job growth, but have in practice been a complete bust.
On the other side there’s California’s turn to the left under Jerry
Brown, which conservatives predicted would ruin the state but which has
actually been accompanied by an employment boom.
So
the economic case for being cruel to the unfortunate has lost whatever
slight credibility it may once have had. Yet the cruelty goes on. Why?
A
large part of the answer, surely, is the usual one: It’s about race.
Medicaid expansion disproportionately benefits nonwhite Americans; so
does spending on public health more generally. And opposition to these
programs is concentrated in states where voters in local elections don’t
like the idea of helping neighbors who don’t look like them.
In
the specific case of Planned Parenthood, this usual answer is overlaid
with other, equally nasty issues, including — or so I’d say — a
substantial infusion of misogyny.
But
it doesn’t have to be this way. Most Americans are, I believe, far more
generous than the politicians leading many of our states. The problem
is that too many of us don’t vote in state and local elections, or
realize how much cruelty is being carried out in our name. The point is
that America would become a better place if more of us started paying
attention to politics beyond the presidential race.
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