Report Reveals Human and Economic Costs of States Rejecting Expanded Medicaid Funding

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By Glynn Wilson

Governors and lawmakers in 25 states who reject federal support to expand state Medicaid programs are sacrificing thousands of lives and pushing away enormous economic development benefits that come with $426 billion in direct funding over 10 years, according to a new report by Health Care for America Now, a grassroots health care advocacy group

While states that fully participate in Medicaid provisions of the Affordable Care Act, otherwise known as Obamacare, will enjoy new federal investment and improved economic growth, residents of states rejecting Medicaid expansion face a declining quality of life, a weaker economy and destabilized hospitals—including some that will be forced to close, according to the report. Research at the Harvard School of Public Health suggests that the 25 states’ refusal to accept the Medicaid funds may result in the deaths of 27,452 Americans in 2014 as those states forgo funding of health benefits that are expected to reduce mortality rates for low-income adults.

“Governors and legislators who refuse to fully participate in Medicaid must face up to the moral and ethical implications of blocking health coverage for their most vulnerable constituents,” said Ethan Rome, Health Care for America Now executive director. “In addition to rejecting billions and denying care to millions, they’re consigning thousands to death. This policy choice is not only unconscionable, it harms everyone in those states whether insured or not. Perhaps the greatest irony of refusing the ACA funding is that it will impose higher costs on insured people in states that claim they can’t afford to expand Medicaid.”

The report indicates that Medicaid expansion can be expected to reduce mortality rates among low-income adults to 6.1 percent below that of neighboring states that reject the program.

In addition, according to a study by Harvard researchers published in the New England Journal of Medicine, extending Medicaid benefits to this population prevents 2,840 deaths per year for each 500,000 adults gaining coverage. Based on this formula, governors and state lawmakers who are blocking access to health care for 4.8 million low-income people will prevent Medicaid from saving 27,452 lives in 2014 alone.

Hospitals in non-expansion states will be put at a significant competitive disadvantage, the report says, resulting in insurance companies excluding them from provider networks because the hospitals must charge insured patients higher fees to cover uncompensated care costs.

Hospital administrators will offset lost network business by increasing out-of-pocket costs for people with private insurance, according to a hospital finance expert and medical school professor at Johns Hopkins University Bloomberg School Public Health. Hospitals in those states are already being negatively affected with higher borrowing costs in Wall Street bond markets from which they obtain funds for construction and other major projects.

“While rejection of Medicaid expansion and other ACA programs may satisfy the ideological fervor of many Republican officeholders, it does not relieve health care providers of the legal and ethical obligation to provide emergency care and stabilization to the uninsured under the Emergency Medical Treatment and Labor Act,” the report says. “That law was enacted with President Ronald Reagan’s approval in 1986.”

The cost of complying with emergency treatment laws will not go away, and the burden of uncompensated care must be borne by hospitals, doctors, local taxpayers and charities.

“In 2009, extremist Republicans intentionally spread phony stories about ‘death panels’ to scare Americans into thinking the law would block their medical care when they needed it most,” Rome said in the press release on the report. “Now it’s clear that the only real death panels consist of Republican governors and lawmakers who are choosing to block the doorway to state Medicaid expansion and keep nearly 5 million Americans away from the medical care they need.”

Health care providers across the country witness the damage caused by unaffordable care and are pushing states to cover more people through Medicaid.

“Every day, nurses and doctors see what happens when patients delay or forgo necessary health care because they can’t afford it,” said Dr. L. Toni Lewis, a board certified family physician and chair for healthcare of the Service Employees International Union. “By refusing to expand Medicaid, extremist politicians have chosen to deny millions of families the care they desperately need and deserve.”

Key provisions of the ACA will take effect on Jan. 1, 2014, when millions of uninsured Americans will begin using subsidized private health plans or expanded Medicaid eligibility to protect themselves and their families from disastrous medical costs.

Washington has devoted five years of raucous public debate to the law so far, and the controversy has shown no sign of letting up as implementation of the ACA’s broadest provisions draws nearer. In October, Republicans shut down the government in a failed effort to force repeal of the law.

Opponents of health reform, including special interest groups spending unprecedented sums of money to undermine the law and its base of public support, have tried every available weapon in their arsenal of legislative, political, legal, regulatory and communications tactics. These include putting intense political pressure on governors deliberating over whether to fully participate in Medicaid. The question for leaders in those states is whether they will rationalize politically motivated policy choices that will inflict serious harm on their own economies and the quality of life for millions of people.

Florida is one of the largest states to say no to Medicaid expansion, and progressive advocates are putting the spotlight on this historic failure of leadership.

“Shame on Gov. Scott and House Republican leaders for failing to expand Medicaid,” said Mishell Warner, a Miami Gardens nurse and member of AFSCME. “I know how devastating this is for the working poor who desperately need health care coverage. There is federal money on the table to get this done, but our political leaders are failing to put the needs of Florida ahead of their political agenda.”

The Progressive Democrats of America are doing the same thing in Alabama.

Edward Savela, Alabama State Leader of the Progressive Democrats of America, said the reason behind Bentley’s refusal to take the Medicaid funds is “a red state cabal of governors who want to discredit Obamacare.”

He said Obamacare is working, despite the glitches reported about the Website.

“What Bentley is trying to do,” Savela said, “is to discredit our president and our president’s wonderful plan.”

© 2013 – 2016, Glynn Wilson. All rights reserved.

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