The most remarkable and unique feature of American politics is one that is rarely discussed: the Republican Party’s extreme anti-statist ideology. The Republican party is the only major conservative party in the world whose governing doctrine rejects higher taxes on absolute principle, refuses to acknowledge anthropogenic global warming, and denies that health insurance should be a right of all citizens. This last point surfaced during the second Republican presidential debate when Ron DeSantis was asked to explain why his state ranks near the national bottom in health insurance coverage. Because these moments occur so rarely, it was highly revealing.
The backdrop is that the Affordable Care Act provided health insurance to poor people by expanding Medicaid. A conservative Supreme Court ruling gave states the right to opt out of the expansion, turning down free funding from Washington if they wished. Originally, just 24 states joined Medicaid expansion. Over time, the sheer economic logic brought more states into the program. Turning down the money not only hurts people who can’t get health coverage, but it also hurts hospitals, which legally must treat people who show up in the emergency room, even if they lack coverage.
In other words, states were not choosing between spending money and hurting people. Helping people get insurance was practically free. (The federal government covers 90 percent of the cost, and the economic benefit of getting health care for the uninsured, both to covered workers and their health providers, easily exceeds the remaining 10 percent cost, paying for itself.) The states that refused to join Medicaid expansion literally had to accept economic sacrifices in order to pay for the privilege of denying health insurance to low-income citizens in their state.
Florida is now one of only ten states that reject Medicaid expansion. DeSantis almost never has to explain or justify this position. Shockingly, he had to do so at the debate.
Stuart Varney asked DeSantis why 2.5 million Floridians lack health insurance, which is a rate much higher than the national average. (Florida ranks fourth from the bottom in residents with health insurance). DeSantis first tried deflecting the problem to overall inflation:
DESANTIS: Well, I think this is a symptom of our overall economic decline. Everything has gotten more expensive. You see insurance rates going through the roof. People that are going to get groceries, I’ve spoken with a woman in Iowa. And she said, you know, for the first time in my life, I’m having to take things out of my grocery cart when I get to the checkout line …
This is obviously a total non sequitur. The uninsured rate in Florida did not get worse due to inflation. Indeed, it got temporarily much better because the Biden administration made emergency COVID-19 funds available to people in non-expansion states, like Florida. In any case, inflation is a national phenomenon that could not possibly explain why Florida ranks near the bottom in health insurance coverage.
Varney, amazingly, pointed this out. He asked DeSantis why Florida’s health insurance rate was “worse than the national average.”
“It’s not,” DeSantis replied. This was a pure lie. (Florida’s uninsured rate is in fact well above the national average, according to the Census Bureau).
But then, DeSantis proceeded to give something like an explanation for his position:
“Our state’s a dynamic state. We’ve got a lot of folks that come. Of course, we’ve had a population boom.
We also don’t have a lot of welfare benefits, in Florida. We’re basically saying we want to — this is a field of dreams, you can do well in the state. But we’re not going to be like California and have massive numbers of people on government programs without work requirements. We believe in your work, and you got to do that. And so, that goes for all the welfare benefits.
And you know what that’s done, Stuart? Our unemployment rate is the lowest, amongst any big state. We have the highest GDP growth events (ph) of any big state. And even CNBC, no fan of mine, ranked Florida the No. 1 economy in America.”
In the middle of this word salad, some coherent thought can be extracted. Florida is a “field of dreams.” It rejects “welfare benefits.” DeSantis never uttered the word “Medicaid” or “Obamacare,” which explains why his state’s citizens lack health insurance at such high levels. Yet he did manage to express his belief that health insurance ought to be an earned benefit, not a right. If people get jobs working in construction or day care or at a convenience store, and those jobs do not have employer-provided health insurance, the state should not step in. Those people should work harder.
Indeed, to give them subsidized access to medical care will sap their incentive. Poor people need motivation to work hard, and denying them the ability to see a doctor and get medicine is part of that necessary motivation. And while Florida is now a minority among states refusing Medicaid expansion, DeSantis’s fanatical stance lies comfortably within the heart of conservative movement thinking. Indeed, this is what is considered “normal” conservatism.
The horrifying nature of this normality is generally invisible. It fell to Fox Business host Stuart Varney, of all people, to make DeSantis explain himself.
How hard is it in the US to move states? With all the dumb stuff that happens, aren’t people fleeing from those states?
If you have no kids, a decent resume, and the desire to do it? It can be a pain.
Imagine if you have kids, not the hottest resume or your skills are otherwise attached to a local economy (say tourism), and you rely on family for childcare. Or you own your house. Or any number of other complications that make it hard to just decide to move.
Remote work has certainly made it easier. You don’t need to travel for interviews like you used to.
Healthcare and ability to rent are both tied to work, so you can’t really just move to a new city and figure stuff out either.
Another thing to consider for someone I assume not from the us: the states, especially Florida, are very big. Moving states means moving very far away. Florida is also deep in the south so moving to a different political climate is an even farther move. Driving from Orlando to Washington DC is a 12 hour trip each way.
You aren’t going to be able to visit family and friends after you move if you are poor.
Besides what the other guy said, you’re typically losing friends, family, any social connection you have and starting fresh. Particularly for poorer folk, this is the prohibitive part of changing states. If you have no money and no connections, turns out it’s really hard to start over.
So it becomes a question of whether or not rebuilding is worth it just to have a shot at health insurance.
Hm I guessed so, but that’s so fucked up. From the outside, the US has issus that shouldn’t be a thing in a first-world country.
1000% agree. 300 million of us suffer because a few thousand of us want to keep getting elected and make obscene amounts of money.
Trivially, from an administrative standpoint. You rent/buy a new place out of state, fill out the local forms to get a new driver’s license and change your residence address. Registering to vote in your new location is often handled by just getting your new driver’s license, and all states offer comity - if you have a license in an US state they’ll give you a new one without a test, just a small fee. Even for professional workers who have to be licensed it’s rarely more than a day or two of hassle and a week to a month of administrative waiting. I’m an engineer and have licenses in 6 states; most allow you to simply fill out forms and pay a fee (and have no judgements on your current license) and they’ll review and issue you a license. Doctors, nurses, teachers, hairdressers, accountants, lawyers are usually similar, though some states have slightly different requirements so you may need to take a test or add some continuing education.
Practically, you need to have some savings - a rarity for Americans. Moving expenses from state to state is similar to moving from one city to another within a state. There is the issue of children in school (mainly the emotional cost of re-making friend groups), and your own social life (mainly the emotional cost of re-making friend groups). And, of course, you will need a job - something harder to find when you are remote, and difficult if you work in a rarefied industry.
It’s expensive as hell, and sometimes even more difficult to pull up roots when you’re deeply embedded in a community. Moving around requires a lot of money that just gets exponentially worse if you have a family to bring with you. And good luck paying for things in the new state while you look for a job! It’s equally tough to arrange to have a job waiting for you in your new home state.
Assuming you have the money to rent a moving truck, pay for the gas, you’vev found a place to live, you have a job where you’re moving, and the will to make it happen… there’s no friction at all.
It’s really just like moving within the same state to a different city, except typically you’re driving further.
You don’t need permission or anything like that.