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Thursday, July 5, 2012 - Page updated at 03:30 p.m.

Froma Harrop / Syndicated columnist
Health-care politics goes into extra innings


Syndicated columnist

There was never much doubt that the individual mandate in "Obamacare" was constitutional. As Harvard Law School professor Einer Elhauge had noted, the first Congress in 1790 passed a law ordering ship owners to buy medical insurance for their seamen. Twenty framers of the U.S. Constitution were members, and President George Washington signed the law.

No, the emotional claim that forcing people to buy a commercial product stomps on basic American rights was a cover for a political campaign to kill the reforms. The Supreme Court removed that fig leaf last week, but the naked politicking goes on.

The next showdown on the program is less dignified. Conservative governors have latched onto the ruling that states won't lose their existing Medicaid funding if they don't expand their Medicaid coverage as envisioned by the Affordable Care Act. Thus, they won't.

In South Carolina, Gov. Nikki Haley's spokesman defiantly announced, "We're not going to shove more South Carolinians into a broken system ... ." Gosh, wouldn't bringing coverage to the uninsured make the system less broken? More to the point, exactly who would be "shoved"?

Contrary to right-wing mythology, America's uninsured are not the idle poor. They already have government-guaranteed health care, as do the elderly, the disabled, government workers and prisoners. Left out are the modest folk who earn too much to qualify under the old Medicaid rules but not enough to afford insurance in the private market (and, by the way, who subsidize others' coverage). The Medicaid expansion is for them.

Nebraska's Republican Gov. Dave Heineman also opposes letting more struggling workers into Medicaid: "As I have said repeatedly, if this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased."

An interesting threat, except for one thing. The Medicaid expansion is funded, certainly by any normal definition. The federal government assumes all the costs in the early years, then 90 percent after that. Furthermore, continuing to drive the uninsured to expensive emergency rooms for routine care is itself a major cost.

Speaking of affordability, the reforms make health care more affordable for government, as well as for families. The Congressional Budget Office projects that the Affordable Care Act will actually cut federal deficits. Here's how:

While the federal government will be spending billions to make insurance obtainable to those without, it will save more than that through other parts of the law that curb costs and add revenues, an estimated $525 billion.

For example, as Medicare now stands, the program must pay for almost any treatment that works, regardless of whether the same could be done for much less. The law prepares government (and private insurers) for more careful spending by funding research to identify $10,000 treatments that do just as fine a job as the $40,000 variety.

Obamacare is also bottom-line good for business and the American economy. It extends tax credits to small companies that cover their workers. (Those that don't are not penalized.) Would-be entrepreneurs will be able to leave their corporate jobs, thanks to reasonably priced family coverage. And everyone who pays for insurance will enjoy the slowdown in spiraling health care costs.

But why let the facts dampen tea party passions? "We can't afford it," insists New Hampshire state Rep. Andrew Manuse, now working with other Republicans to reject the millions the feds are offering for Medicaid expansion. "Thank God the Supreme Court gave us an option."

Yes, the Supreme Court gave states an option — the option to be both foolish and cruel at the same time. Go ahead and stay behind. Everyone else is moving forward.

Providence Journal columnist Froma Harrop's column appears regularly on editorial pages of The Times. Her email address is fharrop@projo.com

© 2012, The Providence Journal Co.