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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.

By Kate Holder / April 11, 2013

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.” '

Deborah Cannon/Austin American-Statesman/AP

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Alexandria, Va.

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. 

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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.

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.

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