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"Seventy-nine out of the 100 counties with the highest levels of medical debt are in states that have not expanded Medicaid under the ACA" Who benefits in thes

"Seventy-nine out of the 100 counties with the highest levels of medical debt are in states that have not expanded Medicaid under the ACA" Who benefits in these 10 states that have still failed to expand Medicaid? What is the upside, to either the populations of these states or the politicians who run these states and make those decisions? Because the downsides are obvious and seem to directly harm a lot of people.

specialist 3y ago
Spite. Segregationists closed public pools and defunded public schools, rather than share with black people. Hurting poor whites as much as poor blacks. Of course they'd also gut the social safety net.
- mrguyorama 3y ago
  Some Americans would gladly eat shit if a black person had to smell their breath after.
toomuchtodo 3y ago
> Who benefits in these 10 states that have still failed to expand Medicaid? The people who run on this as a component of their platform.
snarf21 3y ago
A lot of these states have big problems with gerry-mandering and there tends to be huge wealth disparity between the few small wealth centers in the state and the rest of the state is extremely poor. The money just isn't being distributed with any sense of equity.
- rayiner 3y ago
  Income inequality is at least as big of a problem, if not bigger, in blue states than red states: https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_income_inequality https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ.... New York is the most unequal state in the country. I don’t know about gerrymandering. In the most recent Texas house election (Texas being one of the major ACA holdouts) republicans won a 12-point seat margin with a 7-point popular vote margin. The governor, which is elected by statewide popular vote, won by an 11 point margin. In the 2022 Tennessee House elections, meanwhile, republicans won 75% of seats with 70% of the popular vote, which is as lopsided as some heavily skewed states like California and New York. (At a certain point, winning more seats than popular votes isn’t due to gerrymandering but just normal population distribution effects.) I suspect the real issue is that, in red states, the democrats tend to be low propensity and younger voters. In Tennessee, Trump beat Biden by 24 points. But the GOP beat democrats by almost 50 points in the popular vote in the 2022 Tennessee House elections.
  - orwin 3y ago
    Income inequality isn't an issue, wealth inequality is. I find it perfectly fine to earn 8 time as much as my artist best friend does as long as we are in a market-based system. What bothers me is that I do not pay enough taxes, and could pay even less by declaring my donations.
    - xyzzyz 3y ago
      [flagged]
      - notacoward 3y ago
        Well yes, since others not paying enough taxes is part of the tax system being unfair, someone who actually cares about fairness would be bothered by it and them personally paying more doesn't fix that. Do you not care about fairness? "You could pay more yourself" has always been more of a snide low-effort attempt to shut down conversation than to engage in it. Please try to do (and be) better.
    - rayiner 3y ago
      I strongly suspect that blue states are even more unequal measured by wealth than by income.
nielsbot 3y ago
Some guesses: - It benefits corporations and the wealthy (whom the government actually work for) in some way - Politicians think running on "rugged individualism" works - Same politicians truly believe in trickle-down economics and austerity.
hello_computer 3y ago
[flagged]
- TOMDM 3y ago
  It's a good thing we can address problems on multiple levels then, the personal responsibility level and when that fails with a social safety net.
  - hello_computer 3y ago
    [flagged]
    - TOMDM 3y ago
      Agreed, but for the people with broken pancreases I bet they're thankful for the safety net.
      - hello_computer 3y ago
        [flagged]
- nradov 3y ago
  Type 2 diabetes doesn't really wreck the pancreas, at least no more than other tissues. The problem is that cells throughout the body become insulin resistant. While it is obviously better to avoid the condition in the first place, most cases if caught early enough can be put into remission by eliminating carbohydrate consumption. (Adherence to such a diet can be difficult for many patients due to economic and cultural issues.)
- Someone 3y ago
  Safety belts and airbags are mediocre solutions, too, but that doesn’t imply you shouldn’t have them, even if you are a very careful driver. Also, like with drivers and car accidents, there are people who happen to get type 2 diabetes even though they do what they can to avoid it.
tedunangst 3y ago
The politicians benefit, and run on a platform of deflection. "Just imagine how much worse it would be if the government helped you."
jfengel 3y ago
The Federal Government covers 90% of the Medicaid expansion costs. Which means that there is a some cost in terms of state taxes. But that's not the reason I usually see expressed. It usually comes expressed like this: “The health care industrial complex made up of hospitals, medical device manufacturers and pharmaceutical companies are the great robber barons of our time,” Oliva said. “The term robber baron is defined by government manipulation, monopolizing industry and price gouging.” “We must reform Medicaid and double down on pursuing common-sense policy reforms to unleash innovation and increase access that can all lead to lowering costs,” Zander said. https://www.jacksonville.com/story/news/politics/state/2020/02/02/after-shunning-medicaid-expansion-florida-republicans-see-political-power-of-tackling-health-care/112227288/ https://www.jacksonville.com/story/news/politics/state/2020/... I'm afraid I don't entirely understand what that means.
tstrimple 3y ago
It's not about who benefits. It's about fucked up cultural priorities. It's not just the politicians who are the problem. The voters who keep electing these people over and over are asking for this too. https://www.bostonreview.net/articles/jonathan-m-metzl-dying-whiteness/ https://www.bostonreview.net/articles/jonathan-m-metzl-dying... > Debates raged in Tennessee around the same time about the state’s participation in the Affordable Care Act and the related expansion of Medicaid coverage. Had Trevor lived a thirty-nine-minute drive away in neighboring Kentucky, he might have topped the list of candidates for expensive medications called polymerase inhibitors, a lifesaving liver transplant, or other forms of treatment and support. Kentucky adopted the ACA and began the expansion in 2013, while Tennessee’s legislature repeatedly blocked Obama-era health care reforms. > Even on death’s doorstep, Trevor was not angry. In fact, he staunchly supported the stance promoted by his elected officials. “Ain’t no way I would ever support Obamacare or sign up for it,” he told me. “I would rather die.” When I asked him why he felt this way even as he faced severe illness, he explained: “We don’t need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.” > At the most basic level, Trevor died of the toxic effects of liver damage caused by hepatitis C. Yet Trevor’s deteriorating condition resulted also from the toxic effects of dogma. Dogma that told him that governmental assistance in any form was evil and not to be trusted, even when the assistance came in the form of federal contracts with private health insurance or pharmaceutical companies, or from expanded communal safety nets. Dogma that, as he made abundantly clear, aligned with beliefs about a racial hierarchy that overtly and implicitly aimed to keep white Americans hovering above Mexicans, welfare queens, and nonwhite others. Dogma suggesting to Trevor that minority groups received lavish benefits from the state, even though he himself lived and died on a low-income budget with state assistance. Trevor voiced a literal willingness to die for his place in this hierarchy, rather than participate in a system that might put him on the same plane as immigrants or racial minorities.
nradov 3y ago
Medicaid expansion under the ACA isn't "free" for state budgets. The Federal government only puts in part of the funding. So by forgoing expansion the state politicians can keep taxes low or continue funding other priorities. Some politicians also have ideological objections to expanding government control over the healthcare system. (I am not endorsing these policies, just explaining some of the reasoning behind them.)
- ecommerceguy 3y ago
  I pointed this out earlier but its important to understand given what's going on in the US currently. >>Federal government only puts in part of the funding Via the issuance of debt.
burkaman 3y ago
I mean, medical debt collectors benefit, and they do have lobbyists.
rayiner 3y ago
Given how often I see the argument that “blue states subsidize red states” I can see why folks who want to maintain their dignity wouldn’t want to expand their reliance on blue state largesse. That money comes with no strings attached. Also, even if it’s true that blue states may bear the brunt of taxes, inflation hits everyone equally.
- maxerickson 3y ago
  Inflation literally doesn't hit everyone equally, prices are set in local markets, not fixed at a national scale. Things like federal mortgage subsidies probably cause more inflation in less affluent regions where housing is less competitive than they do in affluent regions (where the competitors for housing aren't particularly pricing their offers to the largest payment they can afford).

specialist 3y ago

Spite. Segregationists closed public pools and defunded public schools, rather than share with black people. Hurting poor whites as much as poor blacks. Of course they'd also gut the social safety net.

mrguyorama 3y ago
Some Americans would gladly eat shit if a black person had to smell their breath after.

toomuchtodo 3y ago

> Who benefits in these 10 states that have still failed to expand Medicaid? The people who run on this as a component of their platform.

snarf21 3y ago

A lot of these states have big problems with gerry-mandering and there tends to be huge wealth disparity between the few small wealth centers in the state and the rest of the state is extremely poor. The money just isn't being distributed with any sense of equity.

rayiner 3y ago
Income inequality is at least as big of a problem, if not bigger, in blue states than red states: https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_income_inequality https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ.... New York is the most unequal state in the country. I don’t know about gerrymandering. In the most recent Texas house election (Texas being one of the major ACA holdouts) republicans won a 12-point seat margin with a 7-point popular vote margin. The governor, which is elected by statewide popular vote, won by an 11 point margin. In the 2022 Tennessee House elections, meanwhile, republicans won 75% of seats with 70% of the popular vote, which is as lopsided as some heavily skewed states like California and New York. (At a certain point, winning more seats than popular votes isn’t due to gerrymandering but just normal population distribution effects.) I suspect the real issue is that, in red states, the democrats tend to be low propensity and younger voters. In Tennessee, Trump beat Biden by 24 points. But the GOP beat democrats by almost 50 points in the popular vote in the 2022 Tennessee House elections.
- orwin 3y ago
  Income inequality isn't an issue, wealth inequality is. I find it perfectly fine to earn 8 time as much as my artist best friend does as long as we are in a market-based system. What bothers me is that I do not pay enough taxes, and could pay even less by declaring my donations.
  - xyzzyz 3y ago
    [flagged]
    - notacoward 3y ago
      Well yes, since others not paying enough taxes is part of the tax system being unfair, someone who actually cares about fairness would be bothered by it and them personally paying more doesn't fix that. Do you not care about fairness? "You could pay more yourself" has always been more of a snide low-effort attempt to shut down conversation than to engage in it. Please try to do (and be) better.
  - rayiner 3y ago
    I strongly suspect that blue states are even more unequal measured by wealth than by income.

nielsbot 3y ago

Some guesses: - It benefits corporations and the wealthy (whom the government actually work for) in some way - Politicians think running on "rugged individualism" works - Same politicians truly believe in trickle-down economics and austerity.

hello_computer 3y ago

[flagged]

TOMDM 3y ago
It's a good thing we can address problems on multiple levels then, the personal responsibility level and when that fails with a social safety net.
- hello_computer 3y ago
  [flagged]
  - TOMDM 3y ago
    Agreed, but for the people with broken pancreases I bet they're thankful for the safety net.
    - hello_computer 3y ago
      [flagged]
nradov 3y ago
Type 2 diabetes doesn't really wreck the pancreas, at least no more than other tissues. The problem is that cells throughout the body become insulin resistant. While it is obviously better to avoid the condition in the first place, most cases if caught early enough can be put into remission by eliminating carbohydrate consumption. (Adherence to such a diet can be difficult for many patients due to economic and cultural issues.)
Someone 3y ago
Safety belts and airbags are mediocre solutions, too, but that doesn’t imply you shouldn’t have them, even if you are a very careful driver. Also, like with drivers and car accidents, there are people who happen to get type 2 diabetes even though they do what they can to avoid it.

tedunangst 3y ago

The politicians benefit, and run on a platform of deflection. "Just imagine how much worse it would be if the government helped you."

jfengel 3y ago

The Federal Government covers 90% of the Medicaid expansion costs. Which means that there is a some cost in terms of state taxes. But that's not the reason I usually see expressed. It usually comes expressed like this: “The health care industrial complex made up of hospitals, medical device manufacturers and pharmaceutical companies are the great robber barons of our time,” Oliva said. “The term robber baron is defined by government manipulation, monopolizing industry and price gouging.” “We must reform Medicaid and double down on pursuing common-sense policy reforms to unleash innovation and increase access that can all lead to lowering costs,” Zander said. https://www.jacksonville.com/story/news/politics/state/2020/02/02/after-shunning-medicaid-expansion-florida-republicans-see-political-power-of-tackling-health-care/112227288/ https://www.jacksonville.com/story/news/politics/state/2020/... I'm afraid I don't entirely understand what that means.

tstrimple 3y ago

It's not about who benefits. It's about fucked up cultural priorities. It's not just the politicians who are the problem. The voters who keep electing these people over and over are asking for this too. https://www.bostonreview.net/articles/jonathan-m-metzl-dying-whiteness/ https://www.bostonreview.net/articles/jonathan-m-metzl-dying... > Debates raged in Tennessee around the same time about the state’s participation in the Affordable Care Act and the related expansion of Medicaid coverage. Had Trevor lived a thirty-nine-minute drive away in neighboring Kentucky, he might have topped the list of candidates for expensive medications called polymerase inhibitors, a lifesaving liver transplant, or other forms of treatment and support. Kentucky adopted the ACA and began the expansion in 2013, while Tennessee’s legislature repeatedly blocked Obama-era health care reforms. > Even on death’s doorstep, Trevor was not angry. In fact, he staunchly supported the stance promoted by his elected officials. “Ain’t no way I would ever support Obamacare or sign up for it,” he told me. “I would rather die.” When I asked him why he felt this way even as he faced severe illness, he explained: “We don’t need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.” > At the most basic level, Trevor died of the toxic effects of liver damage caused by hepatitis C. Yet Trevor’s deteriorating condition resulted also from the toxic effects of dogma. Dogma that told him that governmental assistance in any form was evil and not to be trusted, even when the assistance came in the form of federal contracts with private health insurance or pharmaceutical companies, or from expanded communal safety nets. Dogma that, as he made abundantly clear, aligned with beliefs about a racial hierarchy that overtly and implicitly aimed to keep white Americans hovering above Mexicans, welfare queens, and nonwhite others. Dogma suggesting to Trevor that minority groups received lavish benefits from the state, even though he himself lived and died on a low-income budget with state assistance. Trevor voiced a literal willingness to die for his place in this hierarchy, rather than participate in a system that might put him on the same plane as immigrants or racial minorities.

nradov 3y ago

Medicaid expansion under the ACA isn't "free" for state budgets. The Federal government only puts in part of the funding. So by forgoing expansion the state politicians can keep taxes low or continue funding other priorities. Some politicians also have ideological objections to expanding government control over the healthcare system. (I am not endorsing these policies, just explaining some of the reasoning behind them.)

ecommerceguy 3y ago
I pointed this out earlier but its important to understand given what's going on in the US currently. >>Federal government only puts in part of the funding Via the issuance of debt.

burkaman 3y ago

I mean, medical debt collectors benefit, and they do have lobbyists.

rayiner 3y ago

Given how often I see the argument that “blue states subsidize red states” I can see why folks who want to maintain their dignity wouldn’t want to expand their reliance on blue state largesse. That money comes with no strings attached. Also, even if it’s true that blue states may bear the brunt of taxes, inflation hits everyone equally.

maxerickson 3y ago
Inflation literally doesn't hit everyone equally, prices are set in local markets, not fixed at a national scale. Things like federal mortgage subsidies probably cause more inflation in less affluent regions where housing is less competitive than they do in affluent regions (where the competitors for housing aren't particularly pricing their offers to the largest payment they can afford).