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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.]

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