The utter bizarreness of Medicaid, GOP pols and their voters

The general upshot of a newly released research study of the Affordable Care Act's expansion of healthcare for the poor might first strike its readers as a pronouncement nestled in the amusingly superfluous. "Saved by Medicaid," compiled by two economists, "contribute[s] to a growing body of evidence that health insurance improves health."

I'd wager that most anyone's unresearched judgment would couch itself in close similarity to the economists' evidence. The paper's importance, however, lies in undevilish details: The ACA's Medicaid expansions "reduced the mortality of the low-income adult population by 2.5 percent, suggesting a 21 percent reduction in the mortality hazard of new enrollees," write Dartmouth's Angela Wyse and the University of Chicago's Bruce Meyer.

This is a big fucking deal.

Such is the study's uplifting side. Its disturbing flip side: "Our findings suggest that lack of health insurance explains about five to twenty percent of the mortality disparity between high- and low-income Americans" — an obvious, even inexorable finding, one might say. Nonetheless, that the disparity requires no express distinction between who lives and who dies in the two socioeconomic groups is a reflection of how Americans just accept that the poor get screwed, lethally.

The economists' assertion of "a growing body of evidence" showing that citizens' mere possession of health insurance improves the nation's health was substantiated in a 2018 NY Times op-ed authored by professor of pediatrics and health policy researcher Aaron Carroll. Of greatest political interest was his observation that "community health centers in urban areas where Medicaid expanded saw no significant changes in quality," whereas rural "health centers in states that expanded experienced significant gains."

Dr. Carroll noted that more inhabitants of areas colored in red (my characterization) received treatment for asthma, obesity and hypertension, and about 427,000 patients made "extra visits for depression." Indeed, the findings of "more than 60 percent" of 77 studies and "440 distinct analyses" of Medicaid's expansion up to the year 2015 were "consistent with the goals of the Affordable Care Act," he wrote.

In a 2023 update of Dr. Carroll's findings, the Kaiser Family Foundation reported that its 2020 and 2021 published reviews of "more than 600 studies" showed that Medicaid's expansion improved not only access to healthcare but the nation's health itself, as it also gained "economic benefits for states and providers."

To the political we return, but not to the normal, traditional stuff of politics. What reigns today throughout the U.S. House's Republican majority is that of the most peculiar, abnormal and profoundly sadistic kind of politics. Ideologically contrary to Medicaid's vast benefits extended to their own constituents, these elected representatives of mostly red, rural, poorer congressional districts are trying their damnedest to make their physically ill voters even sicker by complicating and thereby reducing the social program's overall reach and effectiveness.

No doubt you've already read about the assorted, stunningly mean-spirited ways in which most Republican pols' are mightily laboring to add yet another twist to low-income earners' historical screwing. Hence I won't repeat them here. But, as if that's not enough in demonstrating their perfect contempt toward voters of poorer means, these politicians of Trumpian personality disorders are doing the weird evil they're doing so that the extravagantly affluent — those with incomes over $4 million a year — would, on average, pick up another $389,000 annually in tax cuts.

Is anyone still wondering, however, why the GOP's tax package wouldn't kick in until 2029? Why the considerable delay? It's so the party's moderate members who are rather skittish about shafting so many of their constituents may have two upcoming election cycles in which those whom they fucked back in 2025 would not yet have felt that immensely disagreeable sensation of their elected representatives' rear entry.

One final note about the new Dartmouth-U. of Chicago study. In the researchers' data diggings they discovered that the public/private intervention of pest control is actually costlier than Medicaid but just as effective in saving one year of life. From this we might project that poor Republican voters would, while still retaining their healthcare in 2026, set about controlling, i.e., exterminating, the cruel, shameless pests they have heretofore sent to Congress.

But project that we cannot, for it impossibly assumes electoral rationality in the promotion of self-interest among Trumpers.