Email #91, Subject: “treated unfairly”?

Your recent letter explaining your position on Medicaid has left me more confused than I was before I read it.

You state that you wish to “reform Medicaid in a way that protects current beneficiaries.” That’s “over 72 million recipients.” This I thoroughly support. And yet in 2016 you voted for ACA repeal legislation that would have eliminated Medicaid coverage for 13 million of those same people. And the repeal legislation currently under consideration by you and the GOP would eliminate Medicaid for tens of millions. How then can you both “protect current beneficiaries” and eliminate them?

You also state that “Medicaid patients are roughly twice as likely to visit the emergency department (ED)” and “shouldn’t be forced to visit an ED to get primary care.” Again, I thoroughly agree. And yet these same individuals, once they have been removed from Medicaid and have no insurance of any kind, will continue to be forced to visit emergency rooms to get primary care. They just won’t be “Medicaid patients” any more. So in that perverse sense your statement is true.

You go on to state that Medicaid needs “reforms that incentivize states to align their own Medicaid programs to their individual needs, as opposed to promoting unrestrained growth and spending.” While this sounds good, “unrestrained growth” refers to the people who joined Medicaid through the ACA expansion. The whole point of the ACA is exactly that sort of “growth.” Calling it “unrestrained” sounds negative, but that is the goal: to insure as many of the previously uninsured as possible.

To “incentivize” states means cutting their Medicaid funding to match their pre-ACA “needs.” You do acknowledge that you will “cap federal funding,” but instead of calling this a cut that will eliminate health insurance for millions, you say that it will “return control” to the states. But if Congress makes these cuts, then states will have less Medicaid money and so much less control, and the people losing insurance will have no control at all.

Finally, you argue that “states who have adopted a conservative approach to Medicaid” should not be “treated unfairly for their responsible fiscal decisions.” You mean the 19 state legislatures that voted not to participate in the ACA Medicaid expansion and so denied insurance to their own constituents who did not have and still cannot afford it. And yet you are concerned only that these states are “treated fairly.”

Although I am disturbed by your intentions to end the ACA Medicaid expansion, I am shocked by the rhetorical lengths you will go to obscure a basic fact: if you repeal and replace the ACA, millions will lose their insurance. I consider that immoral. Given your contorted efforts to hide that fact, you fear the rest of America does too.


Author: Chris Gavaler

Chris Gavaler is an associate professor at W&L University, comics editor of Shenandoah, and series editor of Bloomsbury Critical Guides in Comics Studies. He has published two novels: School for Tricksters (SMU 2011) and Pretend I’m Not Here (HarperCollins 2002); and six books of scholarship: On the Origin of Superheroes (Iowa 2015), Superhero Comics (Bloomsbury 2017), Superhero Thought Experiments (with Nathaniel Goldberg, Iowa 2019), Revising Fiction, Fact, and Faith (with Nathaniel Goldberg, Routledge 2020), Creating Comics (with Leigh Ann Beavers, Bloomsbury 2021), and The Comics Form (Bloomsbury forthcoming). His visual work appears in Ilanot Review, North American Review, Aquifer, and other journals.

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