Unless, that is, the poorer, sicker and more Republican red states did the unthinkable and said no to the help from their blue state brethren.
Five years later, that tragedy is exactly what has come to pass. While as many as 23 million Americans obtained health insurance during the first enrollment period for the Affordable Care Act, millions more were needlessly left without coverage in the reddest of red states. Because 24 GOP-controlled states rejected Obamacare's Medicaid expansion that virtually pays for itself, seven million residents remain insured. Up to 17,000 of them are projected to needlessly die—every year. By refusing to run their own exchanges, blocking the outreach of "navigators" that Medicare has used with great success for more than 20 years and turning to myriad other obstructionist tactics, states like Rick Perry's Texas, Bobby Jindal's Louisiana and Nathan Deal's Georgia have accomplished what five years ago seemed impossible.
Republicans have made the yawning gap between blue and red state health care worse.
The steep decline in the ranks of the uninsured tells the tale, or at least part of it. Two recent Gallup surveys showed that the percentage of uninsured in the United States dropped from 18.0 percent last fall to 15.6 percent in April, its lowest level since 2008. But most of the newly insured are in those generally Democratic states which embraced Obamacare, cutting their uninsured rates from 16.1 to 13.6 percent, an impressive 2.5 point decline. But the rejectionist red states have hardly moved the needle, with the uninsured rate edging down by only 0.8 percent from 18.7 to 17.9 percent among adults 18 and older.
Those top-level numbers, however, obscure the magnitude of the very real—and completely unnecessary—human suffering in the reddest of red states. California enrolled 1.4 million people under the ACA, while New York signed up 900,000 more. (In the highly regulated Empire State market, premiums fell by half). But as a new assessment this week from the Kaiser Family Foundation revealed, almost 80 percent of the adults caught in the “coverage gap” reside in southern states. Two-fifths of them are white. As dire as KFF’s forecasts for GOP-controlled states were in January, the reality is still staggering. Between them, Texas and Florida, two states in which Republicans said no to the Medicaid expansion and impeded just about every other Obamacare initiative they could, those who could been covered constitute almost 40 percent of the national total.
Continue reading about the growing blue state-red state health care gap below.
The deal the federal government is offering states on Medicaid is too good to refuse. And that's particularly true for the red states.Yup, all but one of the 10 states which stood to benefit most by expanding Medicaid to 133 percent of the federal poverty level (FPL) voted for Mitt Romney. Nine of the 10 benefiting least gave their electoral votes to Barack Obama.
As a hypothetical example, if Mississippi opted out of the 2014 expansion of Medicaid, poor childless adults wouldn't gain coverage in that state. At the same time, the state could roll back eligibility for parents with children who are currently enrolled, reducing the number of participants in the program.And as Glenn Kessler explained in the Washington Post in 2011, it is hard to believe that a state like Mississippi could make it current program any worse:
Mississippi provides some of the lowest Medicaid benefits to working adults in the nation. A parent who isn't working can qualify only if annual family income is less than 24 percent of the poverty line. Working parents qualify only if they make no more than 44 percent of the federal poverty level. Seniors and people with disabilities are eligible with income at 80 percent of the poverty line...Ultimately, several of the states listed in the charts above expanded Medicaid. Thanks to Democratic Gov. Steve Beshear, Kentucky established the Kynect program, which has now enrolled 413,000 residents in Medicaid or private insurance. Arkansas Democratic Gov. Mike Beebe turned to a private option negotiated with the Department of Health and Human Services (HHS) enabling 155,000 newly Medicaid-eligible Arkansans to purchase coverage from insurance companies. And while four hospitals in Georgia have already closed because GOP Gov. Nathan Deal refused to accept Medicaid coverage for over 600,000 Peach State residents, in Mena, Arkansas the 9th Street Ministries free clinic is closing its doors after 16 years because its services are no longer needed by the poor residents who have now obtained health insurance thanks to the Affordable Care Act. It's no wonder the private option approach is very popular among Arkansans, unless they are first informed that it is part of Obamacare. (That's also why Kentucky and Arkansas give Obamacare higher marks than Louisiana and North Carolina. Yet, even in those rejectionist states, residents do not want to repeal Obamacare.)
Translated from the federal poverty guidelines, that means a working Mississippi couple with one child could earn no more than $8,150 a year and still qualify for Medicaid, seniors and people with disabilities could earn no more than $8,700, and a pregnant woman could earn no more than $20,000 a year.
That's the conclusion a team of researchers from Harvard Medical School recently published in Health Affairs. The authors of "Opting Out Of Medicaid Expansion: The Health And Financial Impacts" tallied up the coming body count in the Republican states that rejected the ACA's extension of Medicaid to millions of their residents:
Nationwide, 47,950,687 people were uninsured in 2012; the number of uninsured is expected to decrease by about 16 million after implementation of the ACA, leaving 32,202,633 uninsured. Nearly 8 million of these remaining uninsured would have gotten coverage had their state opted in. States opting in to Medicaid expansion will experience a decrease of 48.9 percent in their uninsured population versus an 18.1 percent decrease in opt-out states. [...]To put those findings in terms Republicans can understand, up to 3,000 of Rick Perry's Texans will needlessly die each year. Those dead will joined by up to 671 from Scott Walker's Wisconsin, 1,176 in Nathan Deal's Georgia, 2,221 in Rick Scott's Florida and 1,145 in Pat McCrory's North Carolina.
We estimate the number of deaths attributable to the lack of Medicaid expansion in opt-out states at between 7,115 and 17,104. Medicaid expansion in opt-out states would have resulted in 712,037 fewer persons screening positive for depression and 240,700 fewer individuals suffering catastrophic medical expenditures. Medicaid expansion in these states would have resulted in 422,553 more diabetics receiving medication for their illness, 195,492 more mammograms among women age 50-64 years and 443,677 more pap smears among women age 21-64. Expansion would have resulted in an additional 658,888 women in need of mammograms gaining insurance, as well as 3.1 million women who should receive regular pap smears.
"When you die and get to the meeting with St. Peter, he's probably not going to ask you much about what you did about keeping government small, but he's going to ask you what you did for the poor. You'd better have a good answer."But thus far, most Republican leaders in Washington and in the states are just doubling down. The party's leaders and presidential aspirants, including Mitch McConnell, Rick Perry, Scott Walker and Bobby Jindal are all campaigning on repealing Obamacare. In Kansas and Georgia, Governors Sam Brownback and Nathan Deal, both facing tough reelection battles, signed laws that shift the decision to accept the Medicaid expansion to the GOP-controlled legislatures. And even as Obamacare critic Robert Laszewski is urging Republican governors to follow in Arkansas' footsteps, conservative think tanks are turning to bogus math to undermine the private option Medicaid program in place there.
And all the while, the long-standing blue state health care advantage will continue to grow. But it didn't have to be this way. It still doesn't. The health care deficit in the red states will begin shrinking as soon as their Republican leaders stop saying "no" and start saying, "thank you."