fresh voices from the front lines of change







I was on Minnesota Public Radio's "The Daily Circuit" yesterday, to talk about the Obama campaign's tailored health care reform pitch to African Americans and Latinos. It's one of the few times I can recall the White House being as specific about the benefits of health care reform as it should have been all along. The basic message is that African Americans and Latinos, who are uninsured at rates much higher than whites, stand to gain a lot from access to preventative care, and other measures to reduce health disparities in both communities. 

But while the White House is working to make African Americans and Latino voters aware of those benefits and how to access them, the president might add that those very benefits are now threatened by the newest "Death Panel" to enter the seemingly interminable health care reform debate.

Meet the newest "Death Panel" on the block.


They are the six Republican governors who have vowed refuse the Medicaid expansion that will happen most other states, under the Affordable Care Act — Rick Scott (FL), Rick Perry (TX), Phil Bryant (MS), Nikki Haley (SC), Terry Branstad (IA), and Bobby Jindal (LA). These Republican governors are opening the "trap door"  that the Supreme Court installed in the Affordable Care Act, even at it upheld most of the law. But it's the poorest residents in these states, many of whom are African American and Latino, and who would have gained health coverage and access to care, that will fall through that trap door. 

While the Court upheld the bulk of the Affordable Care Act, it weakened the Medicaid expansion written into the bill.  Since Medicaid is a federally-funded, state-administered program, under the health care reform law, the federal government would pay 100% of the state governments' additional costs for the first three years of the Medicaid expansion, and 93% each year after that.  As the law was written, the federal government could take away the existing Medicaid funding of states that refused the Medicaid expansion. However, the Supreme Court ruled that states could refuse to expand their Medicaid programs, and the federal government can't penalize them by taking away their existing Medicaid funding.

In other words, the Court left the "carrot" but took away the "stick," and in the process cut a hole in health care reform just big enough for millions of Americans who need its benefits the most to slip right through.

The Medicaid expansion as written would give coverage to 11.5 million uninsured Americans. Because, according to the CBO, that means about 3 million people who would have been covered will be left uninsured. Those 3 million are likely to be among the poorest residents in those states, who now stand to be left out of the benefits of health care reform

 That's also what qualifies these governors for membership in the newest "Death Panel." Medicaid expansion is a proven lifesaver.

A new study from Harvard School of Public Health (HSPH) finds that expanding Medicaid to low-income adults leads to widespread gains in coverage, access to care, and—most importantly—improved health and reduced mortality. It is the first published study to look specifically at the effect of recent state Medicaid expansions on mortality among low-income adults, and the findings suggest that expanding coverage to the uninsured may save lives.

…The HSPH researchers, including senior author Arnold Epstein, chair of the Department of Health Policy and Management, and Katherine Baicker, professor of health economics, analyzed data from three states—Arizona, Maine, and New York—that had expanded their Medicaid programs to childless adults (aged 20-64) between 2000 and 2005. They selected four neighboring states without major Medicaid expansions—New Hampshire (for Maine), Pennsylvania (for New York), and Nevada and New Mexico (for Arizona)—as controls. The researchers analyzed data from five years before and after each state’s expansion.

The results showed that Medicaid expansions in three states were associated with a significant reduction in mortality of 6.1% compared with neighboring states that did not expand Medicaid, which corresponds to 2,840 deaths prevented per year for each 500,000 adults gaining Medicaid coverage. Mortality reductions were greatest among older adults, non-whites, and residents of poorer counties. Expansions also were associated with increased Medicaid coverage, decreased uninsurance, decreased rates of deferring care due to costs, and increased rates of “excellent” or “very good” self-reported health.

The study showed that the groups who benefitted from Medicaid expansion — older adults, minorities, and people living in low-income areas — have traditionally had higher mortality rates and barriers to care (because insurance companies became very adept at excluding those populations, in order to avoid greater "losses" from having to pay for health care).

For African Americans and Latinos, this has resulted in long-standing health disparities that health care reform was intended to eliminate. Now, the Supreme Court ruling threatens to lock those disparities in place.

Medicaid—funded jointly by the federal government and the states—is the nation’s health care plan for the working poor, those in poverty and their children. Enlargement of Medicaid is the single most important provision of the Affordable Care Act for people of color. It’s the way that almost all non-whites covered by the law would receive insurance.

…Protracted state-by-state fights over Medicaid expansion will prolong both uncertainty and suffering. It’s what’s happened since the war over Medicaid began in the mid-1990s, when the Clinton administration began encouraging states to expand the program. The Bush administration came to office and did the opposite, prodding states around the South and the Midwest to come up with inventive ways to kick people out of it.

Medicaid remains a bitterly fought over program today. The ruling yesterday will make it more so.

For people of color, the impact of the mess that the court just rolled down Pennsylvania Avenue and out into the country cannot be understated. Blacks, Latinos and Asians are up to three times less likely to have insurance than whites. Half of the nation’s uninsured are people of color.

The Center for American Progress estimates that this racial gap in health care coverage costs the country $415 billion a year in lost productivity.

For black and brown America, affordable, quality healthcare is key to closing a wider economic gulf.

Medicaid is a lifeline for African Americans and Latinos with serious heath care needs, providing a significant portion of coverage for people with conditions ranging from cancer to heart  disease and stroke. The Medicaid expansion was intended to extend that lifeline to millions more. The six Republican governors who've declared their intention to buck Medicaid expansion are essentially cutting that lifeline, and abandoning the poor, black and brown in their states. Because none of them have proposed an alternative that would extend coverage and offer equivalent benefits to their constituents who would otherwise have benefited from the Medicaid expansion, the decisions of these governors ensured that the uninsured in their states are likely to stay that way.

The sad irony is that many of the governors refusing the expansion are those whose states stand to gain the most from it, because some of them have the highest percentages of uninsured residents in the country. In many cases, the majority of those uninsured are African American or Latino.

Texas is a prime example, with the highest rate of uninsured residents in the country — nearly 25% of the state's population; 5.6 million children and adults. Of those, 71% belong to households with at least one full-time worker, and 63% of the uninsured in Texas are employed. The problem is that many jobs in Texas are low-paying jobs that don't offer health insurance. The percentage of employers offering health insurance in Texas is ten percent lower than the national average.

States like Florida, South Carolina, Louisiana and Mississippi are not far behind Texas.

Florida's Rick Scott is the big loser on this front, with 21 percent of his constituents uninsured. He's already rejected the expansion, even though more than a fifth of his state's population is without coverage. "We already have a Medicaid program that covers the most vulnerable people in our state," he says. So they take care of the "most" vulnerable but everybody else is on their own. If you're poor in Florida, your only hope for help is to get more poor.

South Carolina's Nikki Haley is right behind Scott, with the uninsured rate at 19 percent. As all teabaggie female Republican governors must, she posted her statement on Facebook, not even giving a reason beyond the political: "South Carolina will NOT expand Medicaid, or participate in any health exchanges. We will not support Pres. Obama's tax increase or job killing agenda."

Not far behind them is Bobby Jindahl. Louisiana's's uninsured are 17 percent of the population, but he says, ”I think it makes more sense to do everything we can to elect Mitt Romney to repeal Obamacare.”

"Poor mouthing"  is typical of these GOP governors, all of whom claim that they can't afford a Medicaid expansion for which the federal government pays 100% of the costs for the first three years and 93% after that period. The absurdity of crying poverty while leaving federal money on the table is bad enough. At The Nation, Richard Kim pointed out that each of these states CAN afford a what amounts two a 2.8% increase in expenditures (three years from now). But they'd have to give up some regressive tax policies in the bargain.

  • Texas could newly insure 1.8 million people, at a cost of $2.6 billion between 2014 and 2019, out of $42 billion in revenue from a modest state income tax.
  • South Carolina could newly insure 344,000 people, at a cost of $470 million between 2014 and 2019, by recovering $690 million in lost revenue from the state's capital gains tax.
  • Iowa could newly insure 115,000 people, at a cost of $147 million between 2014 and 2019, out of $3.9 billion in lost revenue from the state's federal income tax deduction.
  • Louisiana could newly insure 366,000 people, at a cost of $337 million between 2014 and 2019, out of $3.9 billion in lost revenue from the state's federal income tax deduction.
  • Florida could newly insure 942,000 people, at a cost of $1.2 billion between 2014 and 2019, out of $5.7 billion in lost revenue from the state's famous "Rent-A-Cow" tax loophole.
  • Mississippi could newly insure 321,000 people, at a cost of $429 million between 2014 and 2019, out of $2 billion in revenue lost due to the state's failure to tax retirement income.


Not only is "We can't afford it!" the big lie about the Medicaid expansion, as Kim says, but the stimulative effect of Medicaid expansion might help states (not to mention citizens) afford much more. Accepting federal money to pay for health care costs can free up state money for other uses. Second, Medicaid spend ripples through local and state economies, mostly in the private sectors. Ultimately, some of that money finds its way to the coffers of state government.

Some already deny themselves any taste of Medicaid's existing stimulative impact by running Medicaid programs that are more restrictive than they need to be (again, Texas is the prime example), that don't go much further than the federally mandated bare minimum. But the real price for bucking the Medicaid expansion will be exacted from the very people the affordable care at was intended to help.

Refusing the Medicaid expansion also means taking needed money away from hospitals that end up serving the uninsured, while passing the cost on to the insured. Thus, health care providers support expanding Medicaid in their states.

Gov Rick Perry expressed his opposition to expanding Medicaid in his state to Fox News, explaining that "Every Texas has health care."

“Every Texan has health care in this state,” Mr. Perry said on Fox News. “From the standpoint of being able to have access to health care, every Texan has that. How we pay for it and how we deliver it should be our decision, not some bureaucrat in Washington, D.C., that may have never been to Texas a day in their life or, for that matter, in any of the other 49 states, trying to mandate this one-size-fits-all health care.”

For the uninsured in Texas, that means a 24-hour-or-more wait at the emergency room. Health care providers say it also means higher taxes for Texans.

In Texas, the burden of paying for the health care of the uninsured falls largely on county residents, whose property taxes help support so-called safety-net hospitals like Ben Taub General Hospital in Houston and University Medical Center of El Paso. Last fiscal year, taxpayers in Houston’s Harris County supplied $504 million and those in El Paso County $54 million to maintain and operate the public hospital districts that treated uninsured Texans in the two counties.

Several local leaders, health policy analysts and officials at urban hospitals across the state said Mr. Perry’s decision to reject billions of federal dollars that Texas would receive in a Medicaid expansion would hurt county taxpayers and the hospitals they support, forcing them to continue to pick up much of the tab for treatment of the uninsured.

Perry's rejection of federal funds to expand Medicaid was too much for at least one Texas lawmaker.

State Representative Garnet Coleman issued a statement and chimed in on Governor Perry’s decision.

The move isn’t just mean, it’s fiscally irresponsible,” said Coleman. “What is now completely paid for by Texas will instead be completely paid for by the federal government for the first 3 years and then 90% for every year after that. The federal government is, in effect, offering to shoulder almost all the cost of care that is currently being financed through counties and hospital districts. The Medicaid expansion will also bring relief to those who already have insurance. Right now, hospitals pass the cost of uncompensated care onto those who can pay, and there is a lot of uncompensated care in Texas.”

I'd flip Coleman''s statement around. This isn't just fiscally irresponsible, it's mean. Not only are these states saying "no" to federal money, they're saying "no" for a chance to improve the health and lives of residents who need help the most.

They are saying "no" to reducing the number of uninsured citizens in their state by half —  and for purely ideological reasons.

So these Republican officials will be saying to their own citizens, "The federal government is offering to give you free health insurance, but we won't let you have it. Your health is less important than us making a statement about how much we hate the welfare state and how much we hate Barack Obama and everything he touches." They believe that it's better for a person to have no insurance at all than to get insurance from the government. That position is morally vile enough in the abstract, but when they're actually confronted with a choice to make about whether to allow their citizens to have health insurance, some of them are going to say no. I struggle to find words to describe how despicable and cruel that is.

It's not all that hard to find words to describe all this. When it comes to saving the lives of their poorest constituents, these Republic governors are effectively saying, "Let them die."




Pin It on Pinterest

Spread The Word!

Share this post with your networks.