Portside

Is Paul Ryan's desire to snatch coverage from millions so he can give an enormous tax break to wealthy people utterly monstrous? Absolutely. But if nothing else, Ryan isn't trying to convince us he believes something he doesn't. Strip away the complex politics involved and it becomes evident that Republican proposals are based upon the belief that, as Ayn Rand preached, the government has no obligation to help anyone.

Without the Medicaid expansion, low-income people across the country would be left with no pathway to affordable health coverage. Repealing the Medicaid expansion would eliminate health coverage for up to, and quite possibly more than, 11 million low-income Americans in the 31 states (plus the District of Columbia) that have taken up this option.

Why has the law been such a flop in a state that had so much to gain from it? When I traveled across Mississippi this summer, from Delta towns to the Tennessee border to the Piney Woods to the Gulf Coast, what I found was a series of cascading problems: bumbling errors and misinformation; ignorance and disorganization; a haunting racial divide; and, above all, the unyielding ideological imperative of conservative politics.

Health Affairs study says single-payer reform could save $150 billion annually on hospital overhead