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Death is the New Republican Badge of Honor
They’re enthusiastically letting people die: low income working people have to put off medical care or, like Charlene Dill, cut their medications in half to be able to buy food for their kids...
In his State of the Union address, President Biden noted:
“So, some of my Republican friends want to take the economy hostage — I get it — unless I agree to their economic plans. All of you at home should know what those plans are.
“Instead of making the wealthy pay their fair share, some Republicans — some Republicans want Medicare and Social Security to sunset. I’m not saying it’s a majority —”
At which point Republicans in the audience started shouting, booing, stomping their feet, and yelling, “Liar!”
They were, of course, trying to keep up the pretense that they actually support Medicare and Social Security, programs the GOP has been openly and enthusiastically trying to kill off since their inceptions in 1966 and 1935 respectively.
But that’s not the worst of it.
The actual plan to sunset Medicare and Social Security had been proudly published a year earlier by Florida Republican Senator Rick Scott as part of his 12-point-plan to “Rescue America.” Or at least rescue American billionaires from having to pay taxes to support programs for “the little people.”
It required all federal programs to sunset after 5 years unless Congress specifically renewed them, including Medicare and Social Security. (Scott dropped that provision a few weeks ago after Biden called him out on it.)
But that’s not the worst of it, either.
The Affordable Care Act passed in 2010, the year that Rick Scott was elected governor of Florida. He’d recently come off a gig as CEO of hospital giant Columbia/HCA which saw his company convicted of the largest Medicare fraud in United States history, a fraud that Scott apparently oversaw since 100% of it happened on his watch.
The company paid an $840 million criminal fine (corporations don’t go to jail, and wealthy CEOs only rarely do), and the company’s board forced Scott out as CEO, but only after he walked away with nearly $100 million that he used, in part, to fund his campaign for governor.
That’s also not the worst of it.
Charlene Dill lived in Rick Scott’s Florida and was working several part-time jobs, house cleaning and babysitting; she’d added a gig selling vacuum cleaners, struggling with medical debt while parenting 3 young children.
As her best friend, Kathleen Voss Woolrich, wrote at the time and later told me in a phone interview for my book The Hidden History of American Healthcare: Why Sickness Bankrupts You and Makes Others Insanely Rich:
“She paid her property taxes and took care of her little trailer, which she owned, and got all three of her kids to school and daycare. She was a very responsible person.”
As Woolrich noted, after feeling pain in her chest:
“She went to the emergency room in 2012 and was told she had heart issues and needed monitoring and medication. But the Florida Republican Party and Governor Rick Scott had turned down $51 billion federal dollars for [Obamacare’s] Medicaid expansion, so she had to work extra to pay for the meds and the ER was her doctor’s office.”
But that, too, wasn’t the worst of it.
On March 21st, 2014 Charlene was planning to get together with Woolrich and her daughter, who’d essentially grown up with Dill’s kids, but first she had to earn a few more dollars to pay for her heart medication, which she’d been cutting back on because of its cost. Medical debt was making life really hard for her.
The Affordable Care Act could have paid for Charlene’s doctor’s visits and medications, but then-Governor Rick Scott was particularly incensed by that prospect and refused — throughout every day of his 8 years as governor — to expand Florida’s Medicaid system under Obamacare, even though the federal government would have paid over 90% of the cost.
So, after spending a long day cleaning houses, Charlene headed out to a lead in Kissimmee, a small town near her trailer near Orlando, where a family had indicated an interest in buying a Rainbow Vacuum Cleaner.
In the middle of the sales pitch her heart stopped, and, in the early evening of March 21, 2014, she fell over, unconscious. The family she was visiting called an ambulance and Charlene was taken to the Poinciana Medical Center, but she was already dead at age 32.
“I am burying my best friend because of [Governor] Rick Scott and the policies of the Republican Party,” Kathleen Voss Woolrich wrote. “She is one of the 7 people who will die each day because the Florida House of Representatives’ Republicans and the Tea Party decided that we are not worth living. We are not worth healthcare. We are not worth Medicaid expansion.”
“I’ll never have her back. I’ll never see my friend again. I’ll never have another day with her because of the [Florida] Republicans.”
But even that wasn’t the worst of it.
Washington Post staff writer Andrew Van Dam, who writes the “Department of Data” column for that paper, discovered that states across the deep south — and Oklahoma and Missouri — have among the lowest credit ratings in the country.
Not the states themselves: their citizens have the lowest credit ratings in the nation. Van Dam looked for correlations that may suggest why this was the case, but couldn’t come up with any.
It wasn’t poverty: other parts of the country had poverty just as bad as parts of the South, but their people had better credit ratings.
And it wasn’t race: other parts of the country had Black and other minority populations in similar proportions to parts of the South but their citizens’ credit ratings were just fine.
It was a mystery, and an expensive one. When your credit rating is low, anything that requires the use of credit costs you more. It’s like a punishment on top of a crisis.
With a low credit rating, your car loan costs more because the interest rate is higher. Ditto for your mortgage and its interest rate. Even renters often pay a higher rate when they have poor credit, a practice justified by landlords to “cover the cost of deadbeats who skip the last months’ rent payments.”
Credit card companies charge more, banks charge more, everybody, it seems, wants to stick it to people with low credit ratings. Payday lenders and pawn shops prey on them. Punishment.
Trying to figure out what was driving the lousy credit ratings across the South — even in economically vibrant areas like Atlanta or Miami — Van Dam writes that he reached out to Urban Institute economist Breno Braga.
While Braga didn’t mention Charlene Dill, he immediately pointed to the same crisis she faced after her heart disease diagnosis:
“The reason why credit scores are so low in the South,” Braga told Van Dam, “has gotta be connected to medical debt, because that’s the most common type of unpaid bill that people have.”
But even that wasn’t the worst of it.
As Van Dam noted when he checked the numbers, it was only happening in states that had one thing in common:
“Of the 100 counties with the highest share of adults struggling to pay their medical debt, 92 are in the South, and the other eight are in neighboring Oklahoma and Missouri…”
These were 11 states with Republican governors; Republican-controlled legislatures; Republican multimillionaires and billionaires funding editorially conservative newspapers and hate-talk radio and TV stations.
Which brings us closer to the very worst of it.
Those states of the South — from Texas to Florida (excepting Arkansas) — along with Missouri and Wyoming are the 11 states that, to this day, have refused to accept federal funds to pay for the Affordable Care Act expansion of Medicaid, the program that could have saved Charlene Dill’s life.
Basic Medicaid — dating back to the 1960s — covers the truly indigent, typically people earning less than $3000 a year, usually because of disability or deeply entrenched regional poverty. It also can pay for long-term nursing care for those with no assets.
But when President Obama pushed the Affordable Care Act through Congress, he expanded the program to cover those who worked for a living but earned too little to qualify or even be able to pay for Obamacare insurance: typically, people earning between $3000 and $15,000 a year (it varies by state).
Suddenly, because of Obamacare, every low-income minimum wage working person in the entire country had access to essentially free healthcare through Medicaid.
Furious, Republican governors sued and took their case all the way to the US Supreme Court. In response, the five Republicans on the Court gutted the ACA, saying it was “unconstitutional” for the federal government to “require” states to offer free healthcare to their citizens even if the feds paid over 90% of the cost.
Because of that ruling, Greg Abbott brags that he won’t give low-income working people in Texas access to Medicaid. Ron DeSantis is proud that he’s carrying on Rick Scott’s tradition of forcing low-income Floridians into medical debt and terrible credit ratings. Ditto for all the other Republican governors who are, to this day, refusing to expand Medicaid.
And Arkansas’ new governor, rising GOP star Sarah Huckabee Sanders, just proposed gutting the Medicaid expansion her state adopted (uniquely among Southern states) back in 2011 by adding an onerous work requirement to it. (Kentucky’s Republican Governor Matt Bevins pioneered this in 2018.) She hopes to have tens of thousands of Arkansans thrown off Medicaid by January 1st of next year.
Rick Scott’s refusal to expand Medicaid arguably killed Charlene Dill and thousands of other Floridians every year since. The story is identical in the ten other states where Republican governors and legislators — with the blessing of 5 Republicans on the Supreme Court — appear to delight in denying their citizens access to inexpensive or free healthcare.
In doing so, these Republican governors are not just producing poorer health outcomes.
— They’re proudly keeping their citizens mired in medical debt, thus ruining their people’s credit ratings and making it ever harder for these working-class folks to escape poverty.
— They’re eagerly stressing and destroying families through that medical debt, a well known cause of divorce, child neglect, and violence against women and children. Some, like Alaska’s Republican State Representative David Eastman, even claim that’s a good thing because when low-income abused children die they’re no longer a cost to his state:
“In the case where child abuse is fatal, obviously it’s not good for the child,” Eastman said, “but it’s actually a benefit to society because there aren’t needed government services or whatnot over the whole course of that [dead] child’s life.”
— They’re enthusiastically letting people die: without access to Medicaid, low income working people have to put off medical care or, like Charlene Dill, cut their medications in half to be able to buy food for their kids.
In other words, refusing to expand Medicaid — withholding access to healthcare for low income working people in their states — is a badge of honor for these Republican governors and legislators.
And that’s the very, very worst of it.