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?