Like most Republicans, Mississippi Gov. Phil Bryant is an Obamacare refusenik. A staunch opponent of the law, he rejected the Medicaid expansion, refused to build an exchange, and won’t encourage Mississippians to enroll in the federal backstop.
All of this is why, according to a recent report, the number of uninsured in the state has grown since last year, when Obamacare went into effect. As of this month, Mississippi has an uninsured rate of more than 21 percent, a 3.34 percentage-point increase over the previous year. By contrast, West Virginia—a similarly poor state that took the opposite approach—has seen its uninsured rate decline from more than 17 percent to an estimate of less than 7 percent, a slightly more than 10-point drop.
Obviously, the bad news made its way to Gov. Bryant. But rather than take responsibility for the consequences of his policy choices, Bryant set a new standard for chutzpah and blamed President Obama. “If statistics show that the ill-conceived and so-called Affordable Care Act is resulting in higher rates of uninsured people in Mississippi,” said Bryant, “I’d say that’s yet another example of a broken promise from Barack Obama.”
So Obamacare’s namesake is responsible for the fact that you can’t be bothered to assist your least well-off residents? It’s a hilarious and pathetic attempt to evade responsibility, if not that surprising; on Thursday, after withdrawing a bill for additional border funding, House Speaker John Boehner slammed Obama for not taking further action, as if he’s responsible for the GOP’s failure (this, the same week the House authorized Boehner’s lawsuit against the president for allegedly overstepping his authority).
But the important point isn’t that Bryant is incoherent, it’s that his inaction—and the inaction of other red states—was predictable. Any time the federal government delegates anti-poverty policy to the states—from Medicaid and food stamps to Temporary Aid for Needy Families and unemployment insurance—some states embrace the programs, providing decent (or even expansive) services, while others adopt the least generous approach available.
Conservative readers might quibble and argue the opposite, that—in the words of a recent Atlantic piece from Richard Epstein and Mario Loyola—a “relentless expansion of federal power” has replaced the “ ’laboratories of democracy’ with heavy-handed, one-size-fits-all solutions,” turning the states into “mere field offices of the federal government.”
This is … exaggerated. Take Medicaid. Yes, it has federal requirements for funding. Expansion aside, if a state doesn’t follow the rules, it loses its share of Medicaid funding. But these rules are basic, and amount to a simple agreement to provide health insurance to the poor. (Indeed, the kind of state that would begrudge requirements like covering adults with children is probably not the kind of state that would build its own insurance program absent federal action.)
Outside of the basics, however, states have considerable discretion in how they tailor their programs. In keeping with their histories as low-tax, low-service states, places like Alabama and Mississippi have aimed for the minimum, providing as little as possible to poorer residents. Neither state offers benefits to childless adults, and both extend benefits only to people far below the federal poverty line (23 percent of the line for Alabama and 29 percent for Mississippi). That captures the poorest residents, but it excludes tens of thousands of poor and low-income households who make no more than a few thousand dollars.