Now that the Supreme Court has one again upheld the Affordable Care Act, it’s time for Republican governors to stop denying coverage to millions and expand their Medicaid programs.
The Supreme Court’s 6–3 decision upholding federal subsidies in the Affordable Care Act doesn’t change anything. It just means that 6.4 million people who depend on federal and state health insurance exchanges for coverage won’t lose their benefits. All of the other provisions of the ACA remain in effect. The ruling represents an unqualified victory for health care reform, and peace of mind for nearly two-thirds of the more than 10 million beneficiaries of health care reform.
What has changed is that, as President Obama said in his reaction to the ruling, “the Affordable Care Act is here to stay. … This is not an abstract thing anymore. This is not a set of political talking points,” Obama said. “This is reality.”
It’s also reality that the Supreme Court’s decision doesn’t change anything for the 4.3 million Americans who are currently prohibited from gaining coverage under the ACA. According to a White House infographic, the 22 states refusing to expand Medicaid will leave 4.3 million Americans uninsured.
It’s no coincidence that ten of the 22 states refusing to expand Medicaid are former Confederate states, or that most are former slaveholding states. Roughly 61 percent of those in the Medicaid gap live in just four states: Florida, Texas, Georgia, and North Carolina.
Opposition to the Affordable Care Act in these states was couched in old “states’ rights” arguments, and colored by coded concerns that Medicaid expansion would primarily help “Those People.” African Americans are disproportionately denied coverage by states refusing to expand Medicaid. Six out of 10 African Americans live in states where governors and legislatures have refused to expand Medicaid. About 1 million African Americans are among those stuck in the Medicaid gap.
It’s no coincidence either that the Republican rejection of Medicaid expansion is increasing racial inequality. Those Southern states clustered in the Medicaid gap have high populations of minorities living in or near poverty. If all of these states expanded Medicaid, 41 percent of uninsured minorities would be eligible for coverage. Among African Americans, 57 percent of the uninsured would be eligible.
Denying coverage to populations in these states increases health disparities. According to a recent study, diabetes is getting diagnosed and treated more among low-income Americans thanks to the Medicaid expansion. The number of Medicaid enrollees newly diagnosed with diabetes increase by 23 percent in the first six months of 2014 in states that expanded Medicaid.
Early detection and treatment of such chronic diseases also contributes to another benefit of expanding Medicaid. In state that accepted the expansion, Medicaid is saving hospitals money by reducing uncompensated costs of treating the uninsured. Those costs are causing hospitals to close in states like Louisiana, where Baton Rouge General Medical Center Mid City recently closed its emergency room.
The Court’s decision also doesn’t change the reality that 36 million Americans would still be left out of health care reform, even if every state expanded Medicaid. These are Americans who earn too much to be eligible for Medicaid, but don’t earn enough to afford health insurance. A single-payer system, like the one President Obama originally proposed, would provide coverage to everyone regardless of income level.
ACA opponents have now lost their last, best chance to repeal the law via the courts. More than 50 congressional votes to repeal or limit health care reform have failed. Two election cycles have failed to give the ACA’s opposition the vote to repeal, or a president who would sign a repeal. It’s unlikely that they will find support for repeal as more and more Americans reap the benefits of reform.
The Supreme Court victory makes it clear: Health care reform is here to stay. It’s time now to expand upon what the Affordable Care Act has started, and make “health care for all” a reality. Expanding Medicaid to extend coverage to millions of Americans is a good first step. It’s time.