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.