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ObamaCare Clusterfuck: Non-Medicaid states privilege legal immigrants over citizens


Arizona’s very conservative governor Jan Brewer, hardly inclined to support much coming from the Obama Administration, recognized this gap in coverage, which got her to switch her position to one in favor of expanded Medicaid coverage. Her compatriot Republican governors, Rick Perry in Texas and Rick Scott in Florida, have not changed their stances. So, immigrants who could and should have been covered by Medicaid will have an opportunity to buy subsidized healthcare coverage on the exchanges, but those current citizens with low incomes who don’t get access to expanded Medicaid will not. As national healthcare coverage rolls toward full implementation, nonprofit advocates are going to have to function as real-time watchdogs, identifying the areas where the implementation of the law reveals areas that need to be patched or fully overhauled.—Rick Cohen

Thing is, though, all schadenfreude aside, there's a lot wrong with this item:

1. Legal immigrants and citizens alike deserve health care as a right. While it's fun to epater the Republicans for shooting their own constituents in the foot, that shouldn't really be the point for a real health care advocate.

2. This is happening because ObamaCare is complex, confusing, and poorly architected. I keep saying that ObamaCare creates second class citizens at every turn because of its architecture -- which in turn comes from Obama's decision to place the insurance companies at the core of his plan -- and this is just another example of that tendency.

3. "You can't buff a turd." When Cohen advocates that nonprofit advocates serve as real-time watchdogs, he's really advocating -- to carry through on the architecture metaphor -- that the construction workers and cleaning people work extra hard to fix the problems the architect built right into the blueprints.

4. More insidiously, getting nonprofit people to accept this role really turns them into fixers as opposed to advocates. Pretty soon, people are going to become invested in their fixes, instead advocating for better solutions. Exactly the same problem will happen, I'm betting, with navigators, and with other non-profits seeking to sign people up.

5. Finally, it's just ridiculous to put overloaded, underfunded (and often, truth to tell, dysfunctional) non-profits into the role of "watchdog." Don't we have Federal agencies to play that role? Or are they so captured that they can't?

Average: 5 (1 vote)


beowulf's picture
Submitted by beowulf on

While it's fun to epater the Republicans for shooting their own constituents in the foot...

You're underestimating how good Republicans are at throwing their golf club in the direction they're walking. This creates a hell of a campaign issue for anti-immigrant activists who will argue the Democrats care so little about real Americans that they're giving tax credits to non-citizens that US citizens are not eligible for.

Submitted by lambert on

I thought the point was that the Republicans fucked over their own constituents. But to do that and turn it into a vote-getter -- that's GENIUS!

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And so we also see the Democrats still playing Washington Generals.....

letsgetitdone's picture
Submitted by letsgetitdone on

They are the Washington Generals. But where are the 'trotters? Did you see the Green Shadow Cabinet? Great people on there.

Submitted by Rick Cohen on

Re nonprofits having to act as watchdogs, yes it is a terrible state of affairs. As an ardent advocate for the public option rather than the Rube Goldberg contraption that resulted, I believe there was a better alternative to what we have now. The dependence on commercial providers (in some states with almost monopoly dominance) makes Obamacare a mess. But the reality is that nonprofits will have to act as watchdogs and work toward improvements, because they have no choice but to, particularly as Republicans muck up the works as best they can to make implementation even more problematic. The reality of nonprofit work is that they are often simultaneously fixers and advocates.