Friday, June 07, 2013
Does Sebelius Have a Racial Subtext?
Doesn't anyone think the maps showing which states have rejected the Medicaid expansion look a bit familiar? Subtract Oklahoma, and you are basically looking at a map of the Confederacy, at least as far as the south is concerned. (Note: some of the maps available on the web are inaccurate -- you have to verify the information state by state and some legislatures are still considering the matter). But I'm sure about my own state because the Louisiana legislature just finished its session without approving the Medicaid expansion -- opposed of course by our Republican Governor Bobby Jindal. There is no question that the vast majority of the people affected -- often described accurately as "poor" and "minority" are, in fact, also "African American" and "Hispanic" and, in the South at least, tend to vote Democratic in presidential elections. The Sebelius case itself highlighted how some states, particularly such as Alabama, historically had extremely low rates of reimbursement under Medicaid which tended to exclude poor blacks from the program. But opting out of a program that would have been initially totally federally-funded really takes the anti-minority cake in my humble opinion. It is not news that obeisance to the values of federalism have historically operated against the interests of blacks and minorities. I'm afraid that when Chief Justice Roberts and six other justices paid homage to those values and created the opt-out, that also created the opportunity for the white south (now the Republican white south) to rise again. But is anyone really proud of the result? Justice Kennedy likes to argue that federalism always promotes liberty. Has the "liberty" of poor blacks and Hispanics been enhanced by the benighted actions of state legislatures operating directly contrary to their interests, actions that may actually kill some of them (as Paul Krugman points out today)? I think not!
" But opting out of a program that would have been initially totally federally-funded "
Initially totally federally funded. INITIALLY totally federally funded. Don't these states have to worry about something beyond "initially"? Having to foot the bill themselves isn't even so far out that Keynes' famous excuse applies.
There is no question that the vast majority of the people affected -- often described accurately as "poor" and "minority" are, in fact, also "African American" and "Hispanic" and, in the South at least, tend to vote Democratic in presidential elections.
Whites make up an overall plurality to majority of current Medicaid dependents in the Red and Purple States rejecting the Obamacare expansion of Medicaid into the middle class, an expansion which would likely increase the percentage of white dependents.
However, you are correct that nearly 3/4 of Medicaid dependents vote Democrat.
By your logic the southern states should be willing to pull out of the Medicaid program altogether since current beneficiaries are poorer (and therefore more likely to be minorities) than those who would benefit from Medicaid expansion. Or maybe they were less racist when they initially chose to participate in the Medicaid program than they are today, as evidenced by the election of white supremacists like Governor Jindal. Or maybe, given that Medicaid beneficiaries apparently receive no health benefits from the program, their participation is just a dastardly scheme to keep minorities from getting good healthcare.
According to your own data in the KFF that is not true for Alabama, Georgia, Louisiana, Mississippi, and South Carolina. In all of those states the % of blacks alone on medicaid matches or exceeds the percent of whites.
It's good that you used the word "plurality to majority" because in Florida, Virginia and North Carolina whites make up a minority of those impacted (and that's rather remarkable since whites make up 60%-2/3 of those state's general population.
But we can give you this, you've got a point about two of the states-Arkansas and Tennessee...
Of course there's a racial component. There's ALWAYS a racial component. States rights has never been anything but an excuse for racial control.
A suggested header for the map:
DEMAGOGUES' RESPONSES TO CHANGING DEMOGRAPHICS
Next, get rid of emergency rooms.
Please reread what I posted.
I am rebutting both the claims that those states opting out are limited to the Old South and that African Americans and Hispanics would make up a "vast majority" of the new middle Medicaid dependents under Obamacare in those states.
The opt out states reach across the country and the total current population of Medicaid dependents in those states (not individual cherry picked states) is not "vast majority" African American and Hispanic.
"... actions that may actually kill some of them.."
Why "may"? The prediction is a sure thing. Lack of coverage kills.
"When Affirmative Action Was White: An Untold History of Racial Inequality in Twentieth-Century America" by Ira Katznelson had shades of this as well.
It is so wrong though to note that certain classes of people are burdened. So mean to call it "racist" to do something with clear implications and effects. It's like saying marijuana criminalization particularly burdens certain groups. So gauche.
As to the future, states aren't required to stay in for all time once they choose to opt in, are they? I would take such "coercion" would be a red flag under Sebelius.
Once a welfare state program is in place and you have a mass of individuals and businesses dependent on the program, it is almost impossible to remove.
Only the rare convergence of Bill Clinton attempting to get reelected as a conservative and the GOP holding Congress partially removed the AFDC entitlement. I can think of no other examples.
Here's one way to look at it. This map shows 14 states that have announced they will not participate:
Here is the % of Medicaid recipients in each of those states that are white (according to this site http://kff.org/medicaid/state-indicator/distribution-by-raceethnicity-4/ ):
By my count only four of those states have %white > 50...In a nation where the % white is about 70% (http://www.census.gov/prod/cen2010/briefs/c2010br-05.pdf)
1) You missed the KS-54%, WY-71%, UT-69%, SD-53, PA-60%, ME-89% and AK-55% opt outs and TN-63% and AR-63% going their own way.
2) We are comparing whites v. blacks and hispanics, not as a percentage of the total. Because there are a substantial percentage of Medicaid dependents who choose other or refuse to self-identify, I noted whites may have either a plurality or majority advantage over blacks and hispanics.
3) At the KFF site, you can break down the actual numbers by state and race. I do not have the time to actually add all of them up, but a glance at the chart broken down this way makes it clear that white Medicaid dependents in these states outnumber blacks and hispanics.
The only real outlier in these states is TX, which has over 2 million Hispanic Medicaid dependents.
As a side note, hispanics is somewhat of a nonsense category because it includes multiple races, a number of whom self identify white or black.
"You missed the KS-54%, WY-71%, UT-69%, SD-53, PA-60%, ME-89% and AK-55% opt outs and TN-63% and AR-63% going their own way."
I didn't miss them, look at the link I noted I used, they are classified as 'leaning no' and I only looked at the 'will not expand' states.
"Because there are a substantial percentage of Medicaid dependents who choose other or refuse to self-identify"
1. Can you point out which states I pointed to would shift from the 'other' numbers?
2. And of course if the charge is that whites in these states are motivated by bad feelings towards minorities then 'other' is relevant.
"white Medicaid dependents in these states outnumber blacks and hispanics"
It seems to me the more interesting number is the number of states in the category for which this is true.
My problem with "subtexts" is that they frequently appear to be an excuse to ignore "texts", and the texts matter a great deal. So, does Sebelius have a racial subtext? Can't really say I care. Especially when I hear this from people who approve of programs that have racial texts.
I am using the data from the links in my lead post. Unless a state has agreed to submit to the Obamacare expansion, it by definition has not.
"Unless a state has agreed to submit to the Obamacare expansion, it by definition has not."
Oh good lord.
Mr. Griffin said at the outset he was talking about states which "have rejected the Medicaid expansion." States which have not decided can't be said to "have rejected" it anymore than someone who has not drawn up a will "has rejected" having one.
Brett, text and subtext can be examined together. This is handled in literature and it can be handled in social science and law.
You can not "care" about the whole picture, but this will hurt full understanding. You repeatedly cite alleged subtext in things you do care about. As to racial texts, e.g., handling a solution for such and such case of racism, they can be judged on the merits.
Mr. W: Mr. Griffin said at the outset he was talking about states which "have rejected the Medicaid expansion." States which have not decided can't be said to "have rejected" it anymore than someone who has not drawn up a will "has rejected" having one.
Obamacare allows states to join at any point and there is no such thing as a permanent rejection or acceptance. For the purposes of this discussion, a state has either currently joined or not joined the Obamacare expansion of Medicaid.
This decision has been pending since 2010 and expansion of Medicaid is supposed to take place in six months. If a state legislature has not yet decided to join the expansion by now, it will almost certainly not do so by 2014.
"Brett, text and subtext can be examined together. This is handled in literature and it can be handled in social science and law."
To echo Mr Wiskas, "Oh, God!" The last thing I want is for social science and law to become even MORE like literature.
We use certain things in each field. We don't use them in the exact same fashion. Doesn't make much sense other than a lazy one liner.
I think there is something to measuring the states who have unequivocally said they are not going to expand, but more importantly when you respond to someone that you not change the terms (in fact you yourself used the word "rejecting the...expansion"; not deciding yet is not rejecting).Post a Comment