Autonomous motherhood

President Obama is increasingly signaling that universal child-care will be the next big national goal for liberals.  After giving the issue prominent attention in his State of the Union address last month, he has continued talking about it in interviews about his goals for the rest of his presidency.

Obama has proposed significantly boosting the tax credit we provide to families for childcare.  It’s doubtful much gets done on the issue in the next two years.  But these proposals and pronouncements are teeing up childcare to play the role for liberals in 2016 that healthcare played in 2008.

Anticipating this, conservatives have begun staking out their opposition early.  Much of the opposition stems from the idea that by subsidizing working parents, liberals stack the tax code against parents who stay home to provide their own childcare.  The National Review blasted Obama’s plan as an attack on the autonomy of mothers who’d prefer to stay home with their children:

Most mothers, especially of small children, prefer to work part-time or drop out of the labor force for a time. Commercial child care is the least favored option for most parents. The president’s plan encourages families to do what they do not wish to do and penalizes them for refusing.

In place of a targeted tax credit for childcare, the editors of the National Review propose a bigger child tax credit for at least some families: “provid[ing] tax relief to all parents who pay taxes, however they structure their lives, by expanding the tax credit for children. Parents would then be able to spend the extra money on commercial day care, or use it to finance a shift to part-time work for one parent, or save it for future educational expenses — or do whatever they chose with it.”

Note how carefully the National Review limits this proposal to “parents who pay taxes.”  If you’re too poor to have any tax liability, you and your children on your own under this conservative plan.

But more broadly, how serious are conservatives about respecting — and indeed, facilitating — the autonomy of mothers to freely choose how to raise their children?  What about a single mother who would like the same opportunity to “drop out of the labor force for a time” to raise her children while they are young?  To preserve this choice for her would require complete public subsidization of her family’s income — the government would have to pay her a basic adequate income for the work of childrearing.

It’s doubtful that conservatives could stomach this kind of expansion of the public dole.  For one thing, a major consequence of 1990s welfare reform was to toss single moms off of public aid. Twenty years later, conservatives show little hint of longing to re-implement AFDC.

Conservatives would also be deeply wary of this kind of subsidization’s effects on incentives for work and to maintain two-parent households.  Paying single parents enough income to stay home with their children, conservatives would argue, inherently weakens the urgency of both going to work and marrying.

These objections are entirely consistent with conservative policy thinking.  But they also sharply limit the conservative defense of motherly autonomy to married, financially-secure women.  That’s a pretty narrow conception of who merits the right to make an autonomous childrearing choice.

In response to President Obama’s plan to help parents pay for childcare, conservatives want to pay stay-at-home moms, too.  That’s an entirely legitimate position — one that, ideally, produces a resulting compromise of a generous child benefit for all low- and middle-income families.

Still, one must question the depth of conservatives’ willingness to defend motherhood autonomy.  Given their policy commitments, the freedom to choose to stay home turns out to be only freedom for a few.

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The conservative Medicaid charade

The New York Times had a good piece last week detailing the still-fraught politics of expanding Medicaid in Red States.  To sum up, while some conservative governors like Mike Pence of Indiana and Bill Haslam of Tennessee are coming around to ObamaCare’s Medicaid expansion, conservative state legislators are still vehemently opposed, and are shooting down carefully crafted expansion plans that their governors had painstakingly negotiated with the Obama administration.

It’s remarkable that the anti-ObamaCare fever still hasn’t ebbed in state legislatures.  But what’s more interesting are the evolving pre-textual arguments that conservatives use to justify opposition to embracing the Medicaid expansion.  Remember, ObamaCare offers the states incredibly favorable terms to expand Medicaid to cover more of the poor and near-poor.  The federal government picks up 100 percent of the costs in the early years of the expansion, and will cover at least 90 percent of the costs forever.

Yet conservatives continue to insist that the federal government won’t meet its obligations.  According to the Times, “Opponents in [Tennessee and Wyoming] said that, among other things, they did not believe the federal government would keep its promise of paying at least 90 percent of the cost of expanding the program. It currently pays the full cost, but the law reduces the federal share to 90 percent — a permanent obligation, it says — by 2020.”

I’ve explained before why this argument is hollow.  The federal government has never made permanent cuts to funding for state Medicaid programs.  Cutting federal funding for the Medicaid expansion would require a change in the law — a change that could only conceivably be enacted by conservatives in Washington.

So this justification is weak to begin with.  But in Tennessee, Governor Haslam called conservative legislators’ bluff with a creative insurance policy: “He had traveled the state to promote [his plan] — and to try to persuade people that it was not part and parcel of the Affordable Care Act, partly because the Tennessee Hospital Association had agreed to pay any expansion costs beyond what the federal government covered.”

Hospitals, of course, are losing eye-popping sums of money in states that have refused to expand Medicaid.  The Urban Institute calculated that hospitals in these states are missing out on some $168 million in reimbursement revenue.  That’s why it’s worth it for Tennessee hospitals to agree to be a last-resort backstop to allay conservative fears that the federal government will bail on its Medicaid guarantees.

Yet even with this guarantee from their hospital sector — and a practical plea to take this incredibly good deal — conservatives in Tennessee stuck to their guns and torpedoed Governor Haslam’s plan.  “Less than 48 hours later,” the Times writes, “his plan was dead after a Senate committee dominated by Republicans rejected it before it could reach the full chamber.”

So why are conservatives still so opposed to expanding Medicaid?  Keep in mind how far to the right the terms of the expansion have shifted from the original uniform expansion called for by the Affordable Care Act.  The Supreme Court opened up the Red State option in 2012, making the expansion voluntary for the states.  This gave conservatives states ample newfound leverage to drive a hard bargain with the Obama administration and to adopt a version of Medicaid on more conservative terms.  In states like Arkansas, Indiana, and Tennessee, the Obama administration has agreed to state proposals to use Medicaid funds to put individuals on private insurance, and even to charge covered individuals small premiums.  It’s a far cry from the original plan, which simply called for an expansion of traditional, single-payer Medicaid.

Yet despite policy concessions from the Obama administration, generous funding terms, and backstop funding by the private sector, conservatives in state government are still holding out.  One Wyoming state senator previewed the revised iteration of the argument against expanding Medicaid: “The argument is that the federal government is already in debt and expanding Medicaid will make it worse,” he said.

This is dumbfounding.  Medicaid is a cooperative federalism scheme, jointly funded by the state and federal governments.  In the warped federalism of this Wyoming senator, the states now have veto power to second-guess Congress’s own budgetary determinations.  Because a state senator from Wyoming somehow knows better than federal legislators what the federal government can afford to spend.

Of course, there’s little reason to engage with the merits of these arguments.  The arguments are hollow, and conservatives barely bother to pretend otherwise.  State level conservatives are simply doing the bidding of their ideological benefactors, the Times notes.  “Tennessee’s chapter of Americans for Prosperity, the Tea Party-affiliated group backed by Charles G. and David H. Koch, and the Beacon Center of Tennessee, a Nashville nonprofit that advocates smaller government, urged the Legislature to scuttle the governor’s plan.”

And scuttle it they did.  Once you cut through the spurious publicly-offered reasons, the real source of conservative opposition to these negotiated plans is straight ideological: that government should be minuscule, and shouldn’t be in the business of guaranteeing healthcare for the poor.  As the Obama administration has learned over and over again, it’s impossible to successfully negotiate with people who oppose government’s basic existence.