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The Geography of Health Reform

In most ways, the vast quantity and heft of conservative institutions is a huge advantage to the conservative movement. But times do come when I think it becomes a problem for the right — in essence people can get caught up in believing their own propaganda, and/or dissonant factual information winds up not reaching people who’d be interested in it. And watching the various state-level efforts to nullify the Affordable Care Act it occurs to me that that’s part of what’s happening here.

What I have in mind specifically is that fact, widely understood but discussed mostly in private in progressive circles, that ACA will effectuate a vast transfer of resources away from “blue” states and toward “red” states. Not by design, obviously, but simply because it’s in the nature of the program to transfer resources away from rich people and toward non-seniors with below-average incomes. And the geography of income in America is such that most of the people with below-average incomes are living in the more conservative states.

In principle you could try to design the bill to tilt away from that outcome, but Arkansas, Louisiana, and Montana are among the ten poorest states and those states’ Democratic Senators were integral to getting the thing done (New Mexico is also in the bottom ten, though I don’t think its Senators were really pivotal players). Consequently, if states like Alabama, Mississippi, Kentucky, Oklahoma, Tennessee, and South Carolina were to succeed in somehow exempting themselves from the ACA they’d basically be turning down free money for no reason. To be clear “this will send money to my state” isn’t a good reason for a member of congress to support a bill that he honestly believes is bad for the country, and conservative voters are the richer residents of the poorer states, but it’s absurd for governors and state legislators to be trying to find ways to turn down what amounts to a gift to their states.

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