The Nut Party

While Republicans are completely wrong, about everything, one of their weirdest wrongnesses has been the refusal of Republican-led states to accept the Medicaid expansion. While this obviously leaves a lot of vulnerable people unable to obtain medical care, it also does substantial economic and institutional damage to their states. That physicians and hospital owners and executives, who are well-to-do and often Republican, have been unable to howl loud enough to overcome the mindless ideological opposition to the Affordable Care Act, is disturbing.

Reiter et al, in Health Affairs, give us an idea where this might be going. States that refused the Medicaid expansion have a disproportionate number of poor, and rural residents. Since the ACA presumed that all the states would accept the expansion, it reduces federal funds that used to go to hospitals that served a disproportionate share of uninsured people. This means that those rural hospitals in the red states are coming under increasing financial pressure. They are financially vulnerable, often losing money, and may start to go our of business. As the authors write, "Policy makers need to formulate strategies for maintaining
access to care for rural populations residing in nonexpansion states."

Do yuh think? But that would mean, you know, spending money. Which Jesus specifically said not to do for the benefit of poor people. It's right there in the Republican Bible. But then what happens when the rich people who live in the same area lose their hospital?