by Walter Brasch
Gov. Rick Perry (R-Texas) opposes the Patient Protection and
Affordable Care Act (ACA), and vows to block the expansion of Medicaid
in his state. At a news conference this past week, Perry, flanked by
conservative senators Ted Cruz and John Cornyn,
declared "Texas
will not be held hostage by the Obama administration's attempt to force
us into the fool's errand of adding more than a million Texans to a
broken system." About one-fourth of all Texans
do not have health care coverage .
According to an
analysis by the
Dallas Morning News,
if Texas budgeted $15.6 billion over the next decade, it would receive
more than $100 billion in federal Medicaid funds, allowing the state to
cover about 1.5 million more residents, including about 400,000
children.
Texas isn't the only state to politicize health care.
Gov. Rick Scott (R-Fla.) says that expanding Medicaid is the "right
thing to do," but the Republican-dominated state legislature doesn't
agree. Gov. John Kasich (R-Ohio) is having the same problem with his
Republican legislature, although participation in Medicaid would save
the state about $1.9 billion during the next decade. Gov. Jan Brewer
(R-Ariz.), one of the nation's most vigorous opponents of the ACA,
surprisingly has spoken in favor of Medicaid expansion to benefit her
state's residents.
Gov. Bobby Jindal (R-La.) and the Republican legislature oppose implementing the ACA and Medicaid expansion. Jindal
says
the expansion would cost Louisiana about $1 billion during the next
decade. However, data analysis by the state's Department of Health and
Hospitals
reveals
that if Louisiana accepted the federal program, which would benefit
almost 600,000 residents, the state would actually save almost $400
million over the next decade. About one-fifth of all Louisianans
lack health insurance .
Pennsylvania, by population, is a blue state, but it has a Republican
governor, and both houses of the Legislature are Republican-controlled.
Gov. Tom Corbett
says he opposes
an expansion of Medicaid because it is "financially unsustainable for
Pennsylvania taxpayers" and would require a "large tax increase." This
would be the same governor who believes that extending a $1.65 billion
corporate welfare check to the Royal Dutch Shell Corp., a foreign-owned
company, is acceptable but protecting Pennsylvanians' health is not.
Fifteen states, dominated by Republican governorships and legislatures, by declaring they won't allow Medicaid expansion,
are on record
as placing political interests before the health of their citizens.
Another 10 states are "considering" whether or not to implement
additional health care coverage for their citizens. The Republican
states, pretending they believe in cost containment, claim they oppose
Medicaid expansion because of its cost, even though the entire cost for
three years is borne by the federal government, the states would pay
only 10 percent of the cost after that. The cost to the states would
average only about 2.8 percent,
according to the non-partisan Congressional Budget office.
If all states agreed to the ACA expansion of Medicaid, 17--21 million
low-income individuals would receive better health care. Among those
would be about 500,000 veterans who do not have health insurance and
whose incomes are low enough to qualify for health care,
according to research
compiled by the Urban Institute. Veterans don't automatically qualify
for VA benefits. Even those who do qualify for VA assistance may not
seek health care because they don't live close to a VA medical facility,
and can't afford health care coverage closer to home. Spouses of
veterans usually don't qualify for VA benefits.
Under the ACA, Medicaid health care would cover persons whose incomes
are no more than 138 percent above the federal poverty line. That would
be individuals earning no more than $15,856 a year, only about $800
above minimum wage. Among those covered by Medicaid expansion would be
women with breast and cervical cancer, and those with mental or
substance abuse problems.
Because they have no health insurance, 6.5 to 40.6 percent of
Americans, depending upon the county they live in, delay necessary
medical treatment, according to research
published in the
New England Journal of Medicine.
The 6.5 percent rate is for Norfolk, Mass.; the 40.6 percent rate is in
Hidalgo, Texas. (Most of Pennsylvania falls in the 6.5--13.4 percent
rate.) Texas and Florida have the highest rates of residents who delay
getting proper medical care because of a lack of adequate insurance.
Low-income individuals who delay getting medical care because of the
cost often develop further complications, some of them catastrophic. The
medical bill that might be only a few hundred dollars, which would be
covered if the recalcitrant states approved Medicaid expansion, could
now become a bill in the thousands of hundreds of thousands of dollars.
The hospitals would have to absorb those costs or force the patient into
bankruptcy, which could impact dozens of other businesses. The Missouri
Hospital Association
reported
if the state refused to accept Medicaid expansion, the state's health
care industry would be forced to accept more than $11 billion in
uncompensated costs.
But, let's assume that the medical condition isn't catastrophic, but
just serious. Low-wage employees, most of whom have limited sick leave,
might be forced to come to work so as not to lose the limited income
they already earn. If their illness is a cold or flu, or some other
contagious illness, they could infect others, both employees and
customers. A waitress, fry cook, or day laborer in the
agricultural
fields with no health insurance could cause massive problems.
Medical problems, such as rheumatoid arthritis, not treated early
would also lead to a severe physical disability, forcing the employee
into becoming unable to work even a minimum-wage job. This, of course,
reduces both income that could be put into the local business economy
and a corresponding decrease in amount of taxes paid. That would trigger
disability payments, which could raise taxes for those who are not yet
disabled.
Research conducted by the Harvard University School of Public Health, and published in the
New England Journal of Medicine,
concluded that expanding Medicaid coverage would result in a 6 percent
reduction of deaths among adults 20 to 64 years old. According to that
study, "Mortality reductions were greatest among older adults,
nonwhites, and residents of poorer counties." For Texas, according to
the research, expansion of the Medicaid coverage would result in about
2,900 fewer deaths; for Florida, it would be about 2,200 fewer deaths;
for Pennsylvania, it would result in about 1,500 fewer deaths.
But, the real reason Republicans may not want Medicaid expansion
could be for the same reason they have been pushing oppressive Voter ID
laws to correct a problem that doesn't exist. Those who are most
affected are those who generally are the low income wage earners and
persons of color, most of whom--at least according to recent
elections--don't vote for Republicans.
[Dr. Brasch's latest book is Fracking Pennsylvania,
which looks at the health, environmental, geological, and economic
impact of natural gas horizontal fracturing. He also investigates
political collusion between the natural gas industry and politicians.]
www.walterbrasch.com
Walter Brasch is an award-winning journalist and professor of journalism emeritus. His current books are
Before the First Snow: Stories from the Revolution ,
America's Unpatriotic Acts: The Federal Government's Violation of Constitutional (more...)
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