By Chris Satullo
Let’s talk today about the differences between workhorses and show ponies.
In government and politics, certain types of jobs nudge people to become workhorses – and actually care about how things get done, compiling lists of real things they’re willing to work to accomplish.
Those jobs tend to be the ones with executive authority, like mayor and governor. To succeed, you can’t adopt a stance of “Reality doesn’t matter; it’s all for show.”
Other jobs – like being a member of a legislature with 50 members or 100 or 435 – dilute the individual’s power to get things done. This tempts officeholders to content themselves with showy acts of political theater that help them get on cable news programs, rule a precinct of Twitter, or suck up speaking fees to rouse the base at annual gatherings.
Granted, some governors have plenty of show pony in them, being prone to symbolic provocations meant to earn primetime minutes on Fox News and praise from the base for “owning the libs.” As current examples, I give you Ron DeSantis of Florida and Greg Abbott of Texas. (I tried to think of similar Democratic examples, but even noisy crooks like Rod Blagojevich of Illinois pushed significant programs through. Help me out here, folks.)
By the same token, some lawmakers are content to work quietly in the shadows on real issues they’re passionate about. Chris Smith of New Jersey is one Republican example whom I know well. Carolyn Maloney of New York (who lost her seat this year due to redistricting) is a Democrat who regularly accomplished useful things.
But here’s an issue that long has separated the gubernatorial workhorses from the show ponies: Medicaid expansion.
Medicaid expansion, part of the Affordable Care Act of 2010, AKA “Obamacare,” is one of the sweetest deals the federal government has ever offered the 50 states. As part of a multi-pronged plan to reduce the then-swelling number of uninsured Americans, Obama decided that the feds would pick up most of the tab for expanding eligibility for Medicaid coverage. (This health coverage for people in the lower brackets of the income scale is a joint federal-state enterprise.)
Then came the Supreme Court’s split-the-baby ruling in 2012 in a lawsuit seeking to overturn the ACA. The ruling preserved much of Obamacare, but permitted states to opt out of Medicaid expansion. Uh-oh. This was an opening for show ponies to do their thing.
Since Team Red’s polemical position on Fox News was that Obamacare was the worst thing to happen to America at least since Pearl Harbor, the bulk of Republican governors followed the dictated political script and refused this incredibly sweet deal. Yeah, that’ll show ’em, the show ponies cried.
No state in the deep South and only one Republican-led state west of the Mississippi (Arizona) initially chose the welfare of its own citizens over obedience to Bill O’Reilly and Sean Hannity. In the Midwest, only John Kasich of Ohio and Rick Snyder of Michigan took the Obamacare deal, refusing to join the show pony stampede.
Since then, reality has intervened.
As anyone not looking at the issue through partisan-tinted lenses could have predicted, the data show that Medicaid expansion was a great success. After the ACA went into effect in 2014, the number of Americans without health coverage dipped from 44.4 million to a low of 26.7 million in 2016, before creeping back up to 30 million during the Trump Administration (hmmmmm). Medicaid expansion played a big role in that, along with the creation of the Obamacare insurance marketplace.
By the way, the state with highest percentage of uninsured (16.7 percent) in 2021 was Texas, run by show pony Greg Abbott, he of power outage and migrant busing fame.
What’s more, even though expansion foes howled to the moon about this “federal mandate” costing their states money, studies show that most states that agreed to expansion reduced both their traditional Medicaid spending and their overall health care budget. Remember, even people without insurance get health care – which many states help hospitals pay for through “indigent care” funds. Today, in the states that opted for expansion, the feds pick up more of that tab.
Impacts go beyond dollars and cents. The National Bureau of Economic Research looked into whether Medicaid expansion was saving any lives. Any study like this of course involves some assumptions and speculation, but here’s what it found: It estimated at least 19,200 lives of adults aged 55 to 64 had been saved between 2014 and 2017 in states that had expanded Medicaid, while 15,600 people died in the non-expansion states due to a lack of health care access that an expanded Medicaid would have cured.
Something else has been dying: rural hospitals across America, 136 of them since 2010. The causes for this are multiple, but the closures are more frequent in states that didn’t expand.
All across red America, reality is seeping into brains that are not addicted to partisan showboating. Red states that originally rejected the Obamacare expansion have been signing on – including Utah, Arkansas, Kentucky, Indiana, Louisiana and West Virginia – while others are considering it. In a number of deep-red states, including Oklahoma and most recently South Dakota, voters have endorsed the expansion via referendum.
Now some Republican lawmakers in places such as Wyoming, Kansas and North Carolina are reconsidering the show-pony script of “Obamacare is a disaster” and looking hard at whether they should act upon the evidence and accept Medicaid expansion.
Take Phil Berger, Republican President Pro Tem of the North Carolina Senate, who recently told Politico, “If there’s a person in North Carolina in public office who’s spoken more in opposition to Medicaid expansion than me, I would like to meet that person. (Now, I’ve come) to the position that expansion is something we should be in favor of and something we probably need to do.”
Our political discourse is addicted to the faulty premise that politicians who, like Berger, change their minds on an issue have “flip-flopped,” which is supposedly a terrible deed. Let me suggest that changing your mind because the evidence and the data have shown your original position to be wrong is actually a praiseworthy, need-to-see-more-of-that thing to do.
(Changing your mind because of a political contribution or personal financial benefit is a different animal – and probably rarer than you think.)
When political parties have been so wrong for so long on so many issues, we voters should want to see an epidemic of the right kind of position-flipping. To encourage that trend, we should avoid using, or falling for, the “flip-flop” accusation – unless there’s clear proof of a venal motive.
Many more virtuous flip-flops are needed to overcome the tone-deaf stubbornness of lawmakers like Wyoming’s Sen. Tom James, who told Politico he thinks Medicaid expansion would benefit employed people making six figures (very much not true), adding, “Every employer I’ve ever worked for has had the option for insurance.”
Uh, Sen. James, you worked for a mining company and a railroad. Sixty thousand Wyoming residents, 13 percent of your state’s population, lack insurance and most of them are working full- or part-time time in jobs that pay a lot less than your old ones or, for that matter, your current, taxpayer-funded one. Extrapolating your personal experience to apply to an entire state is not evidence; it’s show-pony arrogance.
It’s great to see signs of a Big Flip-Flop on Medicaid, of the Bergers beginning to outnumber the Jameses, of show ponies turning into workhouses.
The trend, if it keeps up, would be good for health outcomes, rural hospitals, and state finances, across an America where reality doesn’t write its story in either blue or red, but in black, white and, sometimes, gray.
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Chris Satullo, a civic engagement consultant, is a former editorial page editor/columnist at The Philadelphia Inquirer, and a former vice president/news at WHYY public media in Philadelphia