A heartbreaking story in The New York Times this week described in detail how some state legislatures’ ideological rejection of federal Medicaid payments is killing their own people. Under President Obama’s Affordable Care Act, 40 states have agreed to take money from Washington to provide medical care for all adults with incomes below 138 percent of the poverty line. Ten states, mostly in the South and all controlled by Republicans, have refused to join them. This has led to an epidemic of rural hospitals closing as they struggle to help patients who show up in emergency rooms. States that refused or only lately took the federal funding accounted for nearly three-fourths of rural hospital closures between 2010 and 2021, according to the American Hospital Association. In the program, states have to cover 10 percent of the cost of expanding Medicaid, while the federal government pays the rest.
The harm falls disproportionately on the poor and people of color and points to the legacy of slavery and Jim Crow that has created two different Americas, one with access to all that our society can provide and the other blocked at nearly every turn. The failure to provide basic preventive medical services also illuminates the cruelty and violence at the core of the contemporary Republican movement, in which a far-right Supreme Court has taken away women’s fundamental right to make decisions about their own lives and comfort within a nation awash in guns.
More than three in five poor Americans without access to Medicaid or Affordable Care Act tax credits are people of color. In the State of Mississippi, for one, more than half are Black; only about a quarter of the state’s Republican-majority Legislature are people of color. Mississippi’s governor, who is opposed to expanding Medicaid for the poor, instead believes its $3.9 billion surplus should go to help eliminate its income tax.
This is literally a matter of life or death. A National Bureau of Economic Research study estimated that in one four-year period, 19,200 more adults ages 55 to 64 survived because of expanded Medicaid coverage. Had the program been in all 50 states, about 16,000 more would have lived. It is not at all hard to see why. Access to medical care, particularly routine checkups and prescription drugs, is proven to stave off the worst outcomes. Yet one Mississippi cardiologist interviewed by The Times said that he routinely saw patients in the late stages of congestive heart failure who had never seen a cardiologist or been prescribed heart medication. Some had as little as 10 percent of their heart function left by the time he got to them.
North Carolina recently joined the ranks of states extending the medical safety net to its low-income adults. However, the prospect of nationwide basic care for all remains dim. Republican legislatures in two of the largest states — Texas and Florida — are dead set against it.
In Florida, an independent national study found, 900 fewer people would die each year if the program were in place and about 650,000 uninsured Sunshine State residents would gain coverage. In addition, Florida would avoid at least $1 billion in lost productivity and other costs, its own chief legislative economist has said. Nonetheless, no change is expected there anytime soon.
Is not saving just one life worth setting aside politics, if only on this one issue? Apparently not in Republican America.