At Forbes.com’s Apothecary blog, the Manhattan Institute’s Avik Roy is cool to the idea of states implementing ObamaCare’s Medicaid expansion by putting those new enrollees in ObamaCare’s health insurance “exchanges”: 

When Arkansas Gov. Mike Beebe (D.) first announced that he had reached a deal with the Obama administration to use the Affordable Care Act’s private insurance exchanges to expand coverage to poor Arkansans, it seemed like an important, and potentially transformative, development. The myriad ways in which the traditional Medicaid program harms the poor have been well-documented, and it looked like Beebe had come up with an attractive—albeit expensive—way to provide the poor with higher-quality private insurance. A Good Friday memo from the U.S. Department of Health and Human Services, however, splashes cold water on that aspiration. It’s now clear that the Beebe-HHS deal applies a kind of private-sector window dressing on the dysfunctional Medicaid program, and it’s not obvious that the Arkansas legislature should go along.

The first reason states should not pursue the Beebe plan is that, like a straight Medicaid expansion, it would inhibit the pursuit of low-cost health care for the poor. 

The second reason is that it would cost even more than putting those new enrollees in the traditional Medicaid program. Economist Jagadeesh Gokhale, who advises the Social Security program on how to make these sorts of projections, estimates a straight Medicaid expansion would cost Florida, Illinois, and Texas about $20 billion in the first 10 years. And that’s in the wildly unrealistic event that the feds honor their committment to cover 90 percent of the cost. President Obama has already proposed abandoning that committment. Congressional Budget Office projections suggest the “Beebe plan” would increase the cost of the expansion by 50 percent. That too should be enough reason to reject the Beebe plan. Neither the state nor the federal government have the money to expand Medicaid at all. Volunteering to make the expansion even more expensive is lunacy. 

The Beebe administration is trying to make its plan seem no more expensive than a straight Medicaid expansion. How? By simply assuming state officials would voluntarily make a straight Medicaid expansion so expensive that the Beebe plan wouldn’t cost a penny extra. The illogic goes like this. If Arkansas were to expand traditional Medicaid, the state would likely need to increase Medicaid payments to doctors and hospitals in order to secure adequate access to care for new enrollees. That would make a straight Medicaid expansion so expensive that the Beebe plan would be no more costly, and might even cost less. 

It’s true, states that implement ObamaCare’s Medicaid expansion would have to increase provider payments to give new eligibles decent access to care. The problem is that Medicaid never does that. Medicaid is notorious for paying providers so little that it access to care is lousy. Medicaid does so year after year, even if people sometimes die as a result. The Beebe administration simply assumed that state officials would magically change such behavior, increase Medicaid’s provider payments to the same levels private insurers pay, and thereby volunteer to make an already-expensive Medicaid expansion even more unaffordable. In that fantasy world, the Beebe plan would be no more expensive. As an indication of how implausible that assumption is, no one had been talking about combining a straight Medicaid expansion with higher provider payments until the Beebe administration needed to make the governor’s plan seem slightly less unaffordable. 

Roy has soured on Beebe-style plans since reading some of the terms and conditions the Obama administration issued on Friday. Yet he still imagines there might be free-market-friendly ways to implement a massive expansion of the entitlement state. Thus he counsels states only to expand Medicaid in exchange for real reforms. We’ve heard that song and dance before. Republicans said the State Children’s Health Insurance Program and Medicare Part D – two Republican initiatives – would lead to Medicaid and Medicare reform. Instead, government got bigger and reform went nowhere. Lucy is going to pull the football here, too. If it is Medicaid reform you seek, the only free-market Medicaid reforms are Medicaid cuts. Roy’s criticisms of the Beebe plan are welcome, though it’s odd to find him to the left of officials in the 15 or more states that are flatly rejecting the expansion.

Dan Balz writes in the Washington Post, as many reporters have this week, 

In 2004, Republicans used ballot initiatives barring same-sex marriage to spur turnout among their conservative voters. That strategy helped then-President George W. Bush win reelection.

But did it? I argued in 2006 that it didn’t:

It’s true that states with such initiatives voted for Bush at higher rates than other states, but that’s mostly because the bans were proposed in conservative states. In fact, Bush’s share of the vote rose just slightly less in the marriage-ban states than in the other states: up 2.6 percent in the states with marriage bans on the ballot, up 2.9 percent in the other states.

Political scientist Simon Jackman of Stanford has more here (pdf). He concludes that the marriage referenda tended to increase turnout but not to increase Bush’s share of the vote. And in a county-by-county analysis of Ohio, he found no clear relationship between increased turnout, support for the marriage ban, and increased support for Bush.

Matthew Dowd made the same point yesterday:

Speaking from experience as the chief strategist in 2004 for President Bush, I saw in close detail how little gay marriage could influence turnout of conservatives or evangelicals.   In 2003 and 2004, we did a series of public opinion tests on different messages related to the micro targeting project that would cause voter groups to turn out more in President Bush’s favor.  We tested social issues as well as messages related to the economy, national security, taxes and the size of the federal government.  Not a single social issue (which included gay marriage) fell on the effectiveness scale in the top eight messages.

Further, in analyzing the election returns in the aftermath of the 2004 presidential race an interesting set of data was revealed.   In states that had gay marriage amendments on the ballot including key target states, there was no statistical difference in turnout of conservatives from states that did not have these amendments on the ballot.  Gay marriage had no effect on turnout even among the most conservative potential voters in both the data before Election Day and the returns on Election Day.

Other senior officials from the 2004 Bush campaign confirm: It wasn’t gay marriage that brought social conservatives to the polls, it was national security and the war on terror.

At any rate, as Balz noted, the politics of gay marriage have changed for sure, in Ohio and elsewhere.

Jim DeMint, former senator and future president of the Heritage Foundation, writes a column for USA Today opposing gay marriage. But like so many social conservatives, he supports his position with a sleight of hand. DeMint writes:

Without strong families grounded in marriage, we cannot hold back the ever-expanding power of government. As the marriage culture weakens, Big Government grows. Just look how the welfare state has expanded as the unwed childbearing rate has grown from single digits in the 1960s to more than 40% today.

Marriage policy exists to encourage a man and a woman to commit to each other permanently and exclusively as husband and wife and to be father and mother to any children. Sound marriage policy strengthens civil society and reduces the role of government.

The erosion of marriage costs taxpayers. And it’s not just conservatives who say this. Even the left-leaning think tank, Brookings Institution, attributed $229 billion in welfare expenditures between 1970 and 1996 to the breakdown of marriage.

Yes indeed. Stable families are less likely to be on welfare. As Ron Haskins and Isabel Sawhill of Brookings write,

Our research shows that if you want to avoid poverty and join the middle class in the United States, you need to complete high school (at a minimum), work full time and marry before you have children. If you do all three, your chances of being poor fall from 12 percent to 2 percent, and your chances of joining the middle class or above rise from 56 to 74 percent. 

But DeMint and other social conservatives make a logical leap when they connect that point to gay marriage. Gay people making the emotional and financial commitments of marriage is not the cause of family breakdown or welfare spending.

When DeMint says that “family breakdown” is causing poverty – and thus a demand for higher government spending – he knows that he’s really talking about unwed motherhood, divorce, children growing up without fathers, and the resulting high rates of welfare usage and crime. 

So why raise the problems of broken families and then propose to prevent gay people from getting married? Why all the focus on issues that would do nothing to solve the problems of “family breakdown” and what DeMint has elsewhere called “the high cost of a dysfunctional society”? Well, solving the problems of divorce and unwed motherhood is hard. And lots of Republican and conservative voters have been divorced. A constitutional amendment to ban divorce wouldn’t go over very well with even the social-conservative constituency. A legal ban on premarital sex would address the problem, but even social conservatives realize that it would be an imprudent exercise of state power. Far better to pick on a small group, a group not perceived to be part of the Republican constituency, and blame them for social breakdown and its associated costs.

But you won’t find your keys on Main Street if you dropped them on Green Street, and you won’t reduce the costs of social breakdown by keeping gays unmarried and not letting them adopt orphans.