Playing Ball In Health Politics

Posted on | September 15, 2025 | 1 Comment

Mike Magee

The massive extension of tax cuts to the super-wealthy and financing of ICE-laced terrorism of immigrants doesn’t come cheap. The Kaiser Family Foundation predicts it will expand the nation’s debt ceiling by $5 trillion and add 17 million to the ranks of the uninsured by 2034. And a big part of the funding baked into the Republican “One Big Beautiful Bill” for the wealthy will come from a familiar political football with a half century plus history – Medicaid.

President Kennedy’s efforting on behalf of health coverage expansion met stiff resistance from the American Medical Association and Southern states in 1960. Part of their strategic pushback was a faint hearted endorsement of a state-run and voluntary offering for the poor and disadvantaged called Kerr-Mills. Southern states feigned support, but enrollment was largely non-existent. Only 3.3% of participants nationwide came from the 10-state Deep South at the time.

Based on this experience, when President Johnson resurrected health care as a “martyr’s cause” after the Kennedy assassination, he carefully built into Medicaid “comprehensive care and services for substantially all individuals who meet the plan’s eligibility standards.” But by 1972, after seven years of skirmishes, the provision disappeared.

Riding a wave of early popularity, President Obama folded in federal subsidization of an expanded Medicaid with broader eligibility for all Americans living at or below 133% of the Federal Poverty Level. Generous federal subsidies of up to 90% of state costs, with acute need being reinforced later by a raging opioid epidemic that targeted disadvantaged and needy Americans disproportionately, led even red-state governors to consider offers for voluntary enrollment.

As the final year of Obama’s second term drew to a close, autonomous state leaders had chosen expanded Medicaid to manage the health care needs of 77 million Americans with high patient satisfaction scores. 34 million of these citizens were children. 2 million mothers that year ushered the newborns in as part of the full-bodied Medicaid prenatal and obstetric coverage. 9 million blind and disabled citizens slept easier each night thanks to the participating governors.

A decade later, 41 states (including DC) are now voluntary participants with primarily federal financing. The ten hold outs illustrated by the KFF graph above are Texas, Mississippi, Alabama, Georgia, South Carolina, Florida, Tennessee, Kansas, Wyoming, and Wisconsin.

One of the last conservative states to join the program was Missouri. The “Show Me State” held tight until their state budget bled bright red in response to mismanagement of the Covid-19 pandemic. The final reversal came in earshot of the new president’s musings about a “health-care plan within two weeks, a full and complete health-care plan” and laughable pledges to “repeal Obamacare” just as 45 million additional Americans became unemployed and uninsured simultaneously.

By a margin of 6% Missourians voted in 2020 to extend health coverage to an additional 200,000 state dwellers. Those votes came dramatically from former conservative leaning suburbans. By then even the state’s rural voters were beginning to get the message, having seen 10 rural hospitals shut their doors in the prior few years.

Now the state’s historic ambivalence when it comes to Medicaid is once again on full display. Their senator, Josh Hawley (R-Mo), suddenly turned camera shy on July 5, 2025, the day after the passage of the “One Big Beautiful Bill” that had earned his support. His irate and powerful state hospital industry was full-throated in their displeasure.

Within a few days, Sen. Hawley vowed that he would introduce legislation to remove measures in the bill that cut Medicaid payments to his Missouri hospitals from the legislation that he had loudly supported.

CEO’s at St. Louis Children’s Hospital, Children’s Mercy Adele Hall Hospital in Kansas City, Shriners Children’s St. Louis, among others were all ears since roughly half of all their revenue comes from Medicaid. Hawley and his colleagues had just green-lighted the elimination of supplemental payments, known as state directed payments, that account for 1/3 of these hospitals Medicaid revenue and 14% of their total revenue.

This is not the first time the famous 45 year old Missouri senator has been called out for an abrupt change in direction. On Jan. 6, 2021, he was caught on tape with “fist raised in solidarity with protesters already amassing at the security gates” – a gesture that according to Capitol police “riled up the crowd.” A few hours later, he reappeared on video, running to the closest exit from the Capitol to avoid the crowd of his supporters now in full insurrection mode.

Contrast this record with 94 year old former Indiana Congressman Lee Hamilton (D-IN), who serves as an honorary co-chair for the World Justice Project, an organization that works to strengthen the rule of law worldwide.

Lee Hamilton is beloved in Indiana where he was elected in 1982 to the Indiana Basketball Hall of Fame, (joining the likes of John Wooden, Oscar Robertson, and Larry Bird) after taking the Evansville Central Bears to the state finals in 1948, and setting scoring and rebound records at De Pauw University in 1951 and 1952.

Hamilton was a member of the large Democratic freshman class that entered Congress with the LBJ landslide in 1964, and served in that role for 34 years. He was asked in 2020 to comment on the factors that make for a great politician. He started by noting that the qualities that get you elected are not necessarily the same as those that mark a successful legislator. Then the former vice-chair of the 9/11 Commission (appointed by George W. Bush) added : “I think the most successful politicians have integrity. When you’re interacting with many others to deal with complex and difficult public policy issues, it’s hugely important that you can trust someone’s word. Most of the politicians I’ve met stay true to what they tell you. They recognize the need to work with others and know that trust matters.”