Because states have the choice to expand their Medicaid program as part of the Affordable Care Act, at no cost to them for three years, many Republican governors and state legislators are deciding to leave many of their poor citizens high and dry without health-care coverage.
I find this interesting because the expansion of the Medicaid program under the Affordable Care Act would benefit mostly Americans living in Republican-leaning states, yet Republicans are blocking this health-care expansion. As stated by Dr. H. Jack Geiger, past president of Physicians for Human Rights, "It is their populations that have the highest burden of illness and costs to the entire health care system."
The expansion of Medicaid was initially mandatory under the ACA, but a Supreme Court ruling made this part of the law optional. As a result, 26 states, mostly in the South, rejected the expansion that would provide health-care coverage for its poorest citizens.
These 26 states, according to The New York Times, "are home to about half of the country's population, but about 68 percent of the poor."
It has been estimated that about 8 million Americans qualify for health insurance coverage under this expansion, but because of actions taken by Republican governors and legislators in the 26 states, only half of them will be allowed to take advantage of the new coverage.
This begs the question: Why do some Republican politicians want to keep some citizens from health-care coverage while hospitals in their states are being forced to pick up the tab? Are they just saying no because this expansion is part of the ACA and they hate anything having to do with Obamacare? Are they just being mean and don't care about their constituents? Or, perhaps they are afraid that their citizens will like the Medicaid expansion and wonder why their Republican representatives worked so hard to deny them coverage?
The federal government pays 100 percent of the Medicaid expansion through 2016. After that, the federal coverage slowly drops to 90 percent over several years. This is quite the deal for states and a big savings for hospitals that end up serving these folks anyway, but without the Medicaid reimbursement. Thus, hospitals in these GOP controlled states are losing billions of dollars in revenue. The U.S. Chamber of Commerce has tried to explain the math to GOP governors and legislatures, but to no avail.
Missouri hospitals, for example, will lose $4.2 billion over the next six years in federal support for uncompensated care if the state does not expand its Medicaid eligibility. The Missouri Chamber of Commerce strongly urged the Missouri Legislature to accept the expansion under the ACA. According to Eduardo Porter, writing for the Economic Scene, "it would expand health coverage in the state's poor, predominantly white rural counties, which voted consistently to put Republican lawmakers into office. Missouri's Republican-controlled Legislature - heavy with tea party stalwarts - rejected Medicaid's expansion in the state anyway."
As Republicans work hard to keep these folks uninsured, it will be interesting to see if this becomes a political issue used by Democrats in places like Missouri and other southern states where Republicans have firm control of state legislatures, but where they consistently vote against the needs of their constituents. Perhaps health-care coverage will be the tipping point for many poor, white southerners who consistently vote Republican and against their own self-interests. Perhaps they will wonder why they continue to support a political party that does everything possible to keep their family members from the health care they need.
Maybe this is why Republicans don't like the Affordable Care Act.