Neoliberal Health Reform After COVID-19: "Universalizing" Care and the Lingering Challenge of the American South

There are few places where the social character of disease and epidemic were more evident than in COVID-19-era United States (US). The epidemic laid bare the brutal reality of wildly unequal and racialized care that prevails in such a heavily privatized system, along with its devastating societal consequences. Politically, they represent a historically contingent opportunity to critique and address healthcare failings, but such opportunities come laden with political strife, particularly in US healthcare. The proposed paper will explore the outcomes of ongoing neoliberal health reform in the US, particularly during and after COVID-19 support measures. In the wake of these measures, it is, oddly, the neoliberal nature of expansion that has undercut the resistance to reform exhibited by the political right. This has, in turn, generated the prospects of near-universal coverage in the not-so-distant future. At the national level, the paper will show why healthcare is now the one area where the political right can no longer call for bombastic austerity. Here, the privatized nature of reform, accelerated in the critical moment of the epidemic, may have changed the rules on health specifically. Consequently, the largest single obstacle to universalization remains the continued Republican resistance in southern states to Medicaid expansion, as conceived in the Affordable Care Act of 2010. Overcoming this hurdle will prove a substantial—though not impossible—task. It will require that the political rules surrounding healthcare are similarly interrupted for state Republican officials, particularly where they hold a ‘trifecta’ of power (the Governorship and both the state assemblies) and a capacity to defy public opinion and constituent interests with relative impunity.