Opinion

Opponents of Medicaid expansion put politics over people

The rejection by several Republican-led states of the Affordable Care Act’s Medicaid expansion to provide health care access to millions of America’s poor isn’t just partisan politics; it’s immoral. It’s not too late to press state leaders to put people ahead of partisanship.

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    Members of Texas Organizing Project yell chants to ask for Medicaid expansion outside Gov. Rick Perry's office in Austin, Texas, April 1. Op-ed contributor Kate Holder writes: It seems that [Mr. Perry] would rather deny Medicaid coverage to 2 million Texans than submit to what he called Obamacare’s “power grab.” '
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The third anniversary of the signing of President Obama’s Patient Protection and Affordable Care Act, also known as “Obamacare,” was recognized last month with the usual debate over its costs and benefits and impact on the federal deficit. 

GOP opponents have objected to the law, often invoking a moral argument that it violates individual and states’ rights. But in their efforts to undercut the law, many of its most vocal adversaries are committing a moral transgression of their own. The rejection by several Republican-led states of the Affordable Care Act’s Medicaid expansion to provide health-care access to millions of America’s poor isn’t just partisan politics; it’s immoral.

Fortunately, states can sign on to Medicaid expansion at any time, so it’s not too late for citizens to press their state leaders to put people ahead of partisanship and help Americans in need.

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To date, as many as 17 states – all led by Republican governors and/or Republican-controlled legislatures – have either refused or are leaning toward refusing the Medicaid expansion. That means denying health coverage to more than 5 million of the 20 million uninsured Americans who would be eligible.

This refusal to provide health-care coverage to some of the nation’s poorest working adults will consign millions of them to a coverage gap that the Affordable Care Act was designed to close. As many America Catholic bishops and other religious leaders have clearly stated: Access to affordable health care is a moral imperative as well as a fundamental human right.

Under the Affordable Care Act, states were granted the option to opt out of the Medicaid expansion without penalty by the Supreme Court last June, in a ruling that also upheld the law’s constitutionality.

Yet Medicaid expansion offers a very favorable deal to the states. It asks states to increase Medicaid eligibility to adults with incomes at or below 138 percent of the federal poverty level. In return, the federal government will pay 100 percent of the cost of expansion for the first three years, and at least 90 percent after that.

That’s 90 percent paid for by the federal government, forever. And if the law failed to follow through with its 90 percent commitment, then states could withdraw at any time.

If all states accepted the expansion, state Medicaid spending nationally would increase by less than 3 percent from 2013 to 2022, according to a November 2012 report by the Kaiser Family Foundation and the Urban Institute.

Many business groups, hospitals, health-care advocates, and health-care providers across the country strongly back Medicaid expansion for reasons both economic and ethical. Those reasons include improving health-care providers’ abilities to save lives and improving health-care outcomes, as well as curtailing costs for hospitals that rack up millions in unpaid bills to treat the uninsured.

Nevertheless, several “red” states have called the expansion too costly. Others are standing on states’ rights principles. Still others reject the expansion in favor of market-based private plans that offer purported but unproven efficiencies.

In Texas, for instance, it seems that Gov. Rick Perry (R) would rather deny Medicaid coverage to 2 million Texans than submit to what he called Obamacare’s “power grab.” Texas has the nation’s highest percentage of uninsured residents at 24 percent.

Other no-expansion states with high rates of uninsured include Georgia (20 percent uninsured), Louisiana (20 percent), South Carolina (20 percent), and Mississippi (19 percent).

Florida Gov. Rick Scott (R) dropped his earlier opposition to Medicaid expansion, saying he could not “in good conscience, deny the uninsured access to care.” Mr. Scott’s fellow Republicans in the state legislature, however, are not on board. They may instead consider some form of “market-based” coverage for the 1 million Floridians who would be left without affordable health coverage.

Market-based alternatives are being considered in other Republican-controlled states as well. The Obama administration is open to alternatives and has in principle agreed to a market-based alternative in Arkansas, although the private plans must meet Medicaid’s strict coverage guarantees.

Proponents of private insurance say recipients will have better access to health-care providers and the benefit of choice. But multiple studies show private plans tend to come with higher provider payment costs, higher rates of cost increases, and no evidence that competition curbs pricing. Private plans also add out-of-pocket expenses that force many low-income people to drop their health insurance to pay for basic necessities.

In addition, private plans could cost up to 50 percent more compared to traditional Medicaid, according to a 2012 Congressional Budget Office report.

But some other Republican governors have made a compelling case for expanding federally funded Medicaid. And some have defended their pro-expansion support on moral grounds. In a February speech, Ohio Governor John Kasich referenced his faith and the Bible to explain his decision to “help the least among us.”

In early March, Arizona Gov. Jan Brewer implored her fellow GOP legislators to look past politics and support the Medicaid expansion. The human cost of opposing it, Brewer warned, would be a “tragedy” that “can’t be calculated.” Ms. Brewer estimated that without Medicaid expansion, 50,000 low-income Arizonans would lose health coverage.

Although both Mr. Kasich and Brewer are facing revolts by their Republican-controlled legislatures, both governors continue to advocate for Medicaid expansion in their states.

Religious leaders have also entered the political fray to make the moral case for Medicaid expansion.

In March, a coalition of more than 1,300 Roman Catholic leaders sent a letter to Pennsylvania Gov. Tom Corbett, calling on him to reverse his denial of Medicaid expansion to more than 500,000 Pennsylvanians. The group said refusing expansion would “breach the moral duty” to the state’s families in need.

And as the recent Easter holy week approached, Roman Catholic bishops across the country made pro-Medicaid expansion overtures in written public statements and in Lenten pastoral letters, reiterating their position that providing affordable health care is a moral imperative. 

In many respects, the debate over Medicaid expansion among the states has only begun. Therein lies the opportunity – that is, for the public to cut through the technical noise and remind leaders that Medicaid expansion represents an unprecedented opportunity to offer access to health care to millions of vulnerable Americans in our communities. It’s the pragmatic – and moral – thing to do.

Kate Holder is a freelance writer and communications consultant. She has written articles as well as corporate and non-profit communications on a broad range of health-related subjects. Visit her website at www.kateholder.com.

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