by Nancy H. Brandt, a Board Member of Protestants for the Common Good.
There is no other way to say it. If some 30 states opt out of the Medicaid
expansion that was enacted as part of health care reform, as they currently
threaten to do, that will be 30 immoral acts. Some governors have given as
their reason that they can’t afford it, but the facts around the funding show
they almost can’t afford not to
participate. And so, one must ask why they would turn down a deal that the Congressional
Budget Office estimates will be 93% paid for over the first nine years, a deal
that hospitals everywhere favor as it will cover presently uncompensated costs.
The obvious and first conclusion is that ideology trumps
everything else. They hate the new healthcare law and its mandate so much that
it takes precedence over any other concern. But a deeper and more troubling
conclusion is that perhaps half of us in America no longer care a jot about the
poor, or the lingering and damaging effects of growing up poor and without
healthcare. Is caring simply no longer important?
The Congressional Budget Office predicts that when it
actually comes to acting, states opting out of the expansion will result in
three million fewer people insured than planned. This coverage gap will be composed of families
below the poverty line, not reachable by the insurance exchanges that will be
set up to cover people from 100% to 400% of the poverty line. This would be a
bizarre outcome, indeed.
What are the likely outcomes for the uninsured poor? Clearly it will make it more difficult to
address racial disparities in healthcare: 22% of African-Americans, 32% of
Hispanics are uninsured, compared with 14% of whites. Opponents of the law
seize upon the administration’s behind-the-scenes efforts to explain the
advantages of the law to black and Hispanic audiences as a negative, as proof
that the health care law is race-based after all and not about the middle
class. When did it become not only unimportant but wrong to address racial disparities?
There are real consequences to being poor and uninsured.
Researchers from the Harvard School of Public Health conclude that states with
more generous Medicaid coverage have lower mortality rates by at least 6%. Do
we care how long poor people live?
Research also points to healthcare improving school
outcomes. A study by Teachers College at Columbia University found students
with chronic illnesses at greater risk of absenteeism and poor school performance.
No surprises there. A recent evaluation of the State Children’s Health
Insurance Program found that school absenteeism rates dropped as children’s
health insurance rates rose under the program. This is not rocket science. But will policy makers make the connection?
A long-term answer, as suggested by both Timothy Noah of The New Republic and more conservative
economist Robert Samuelson, is to federalize the entire Medicaid program, just
like Medicare, if it is no longer feasible to maintain a federal-state
partnership.
But even that solution requires that a majority of the
Congress and perhaps a majority of the electorate believe that our nation
should care about all its citizens, and especially about the poor. It comes down to what kind of a country we
want to live in.
