One day before voters head to the polls, several factors seem to be fueling Republican Scott Brown's surprising lead over Martha Coakley in the Massachusetts Senate race. Voter anger over the economy, Coakley's weak candidacy and Brown's strength among independents who now dominate Bay State politics are just some of the dynamics at work. But when it comes to health care, voters in a state where 97% of residents already have insurance simply may not want to fund coverage for their fellow red state Americans.
Polling and anecdotal data suggest the force of the "I've got mine" argument. While Massachusetts in 2006 enacted an individual insurance mandate that sharply reduced the rolls of the uninsured, the reddest of red states (led by Texas) still have up to quarter on their non-elderly residents without coverage. And Brown supporters like independent Joey Buceta don't want to pay for them:

"In this state, we basically have universal health care. Why should we pay more money for it? We already have it."

For his part, Scott Brown wants to deny other Americans not only the health care benefits his state now enjoys, but ones he supported for in the Massachusetts legislature:

"We already have 98 percent of our people insured here in Massachusetts, so you have to be a little bit parochial here," Brown said last week during a visit to a medical devices company in Chelmsford. "We're going to be basically paying for our plan, and then we're going to be subsidizing Nebraska and Louisiana...boy, that's a real bargain."

Appearing on Fox News last week, Brown echoed Romney advisor Ron Kaufman's assessment of Massachusetts voters and health care, "They already paid for it." Brown told Neil Cavuto:

"Why would we subsidize and why would we pay more for something we already have. It makes no sense."

Recent polls seem to suggest that view is resonating in blue state Massachusetts. The final Public Policy Polling survey released yesterday found that "the likely electorate for Tuesday's election continues to express skepticism about the Democratic health care plan with 48% saying they're opposed to 40% who support it." A Suffolk University poll revealed that respondents' support for the individual insurance mandate in Massachusetts does not translate to backing for it at the national level:

• 54 percent support Massachusetts' near-universal health care law
• 62 percent believe Massachusetts cannot afford its health care system
• 51 percent oppose the proposed national health care plan
• 61 percent believe the federal government cannot afford the proposed national health care plan

But as I detailed three weeks ago ("Blue States Balk at Funding Red State Health Care"), these concerns are hardly limited to Massachusetts. As it turns out, blue states which have already expanded their own Medicaid programs face the double whammy of underwriting red state health care while receiving less federal support due to their own past generosity.
The New York Times detailed the quandary for several (mostly blue) states "pushing back against the Senate overhaul bill, arguing that it unfairly penalizes them in favor of states that have done little or nothing to extend benefits to the uninsured." That would be just the latest example of "red state socialism" in which a one-way flow of federal taxpayer dollars from Washington DC subsidizes programs in southern, Republican states:

With tax revenues down and budgets breaking, the states -- including Arizona, California, New Jersey, New York and Wisconsin -- say they cannot afford to essentially subsidize other states' expansion of health care.
The bill passed by the Senate on Thursday would move toward universal health insurance coverage in large part by expanding Medicaid, a program whose costs have traditionally been shared by the states and the federal government.
But the roughly 20 states that have already expanded coverage in some form will pay a greater proportion of their new Medicaid costs under the bill than those states, largely in the South, that until now have covered relatively few of their poorest residents.

As the Times explained, "governors in the states that have done more to broaden coverage are now lobbying their Congressional delegations to eliminate the discrepancies as the two chambers reconcile the bills," and with good reason:

Under the Senate bill, the federal government would pay the entire cost of expanding Medicaid to those not already eligible under state coverage for the first two years of the program. The following three years, states that do not now have expanded coverage would be reimbursed at a higher rate than those states that do -- in general, the states without expanded coverage would be paid back 95 percent of their costs, while those that have already expanded coverage would be reimbursed between 80 percent and 95 percent. Medicaid reimbursement rates are based on per capita income; wealthier states have smaller shares of their costs paid back.
The biggest hit to states that have already expanded will be in covering the people who are eligible now but have not signed up for coverage under the state's current program. They are expected to enroll because the new legislation will require almost all Americans to have insurance...
...For example, the federal government would pick up the entire cost for the first two years and 95 percent of the cost for the next three years for newly covered working parents in Alabama, which now covers only those making up to 24 percent of the federal poverty level.
But it would pay just 50 percent of the cost for most of those newly enrolled in California, because California already makes eligible working parents earning up to 106 percent of the poverty level and its Medicaid assistance is set at 50 percent. California would get a more generous reimbursement, about 83 percent, only for parents earning from 106 percent to 133 percent of the federal poverty level.

As it turns out, this battle is just the latest irony in the war over health care reform. As the data show, health care is worst precisely in those states where Republican poll best.
And as Massachusetts sadly shows, not all blue staters are willing to pay to fix it.