Rachel MacLean: Playing politics with Medicaid



Despite its reputation as a landmark ruling, the Supreme Court's June 2012 decision on the Affordable Care Act was not entirely damage-free.

On Feb. 13, Wisconsin Governor Scott Walker became the 14th state leader to announce he will turn down federal money allotted by the ACA to expand Medicaid. The decision made by Walker and 13 other Republican governors has illuminated one of the biggest problems created by the Supreme Court's ruling: it made the ACA's Medicaid expansion optional.

Now, in states that choose not to expand Medicaid, many Americans with incomes below 100 percent of the federal poverty line will be left uninsured due to lack of funding. This is particularly ironic given that people at 100-400 percent of the federal poverty line will receive subsidies under the ACA to ensure they can afford coverage.

Ideally, this caveat would never have mattered, but with 14 states now opting out of the expansion, some of America's most impoverished citizens will be put in the frightening position of lacking medical coverage. To make matters worse, the opt-out list includes two of the five states with the highest uninsured rates in America: Texas and Georgia.

Recently, governors Jan Brewer in Arizona, Susana Martinez in New Mexico, and Rick Scott in Florida have announced their acceptance of the Medicaid expansion in their respective states, reversing their previous stances condemning the policy. These surprising swings suggest that compelling financial and social reasons exist for states to implement the change.

Indeed, the social justice argument for Medicaid expansion is strong. American's poorest citizens will be unfairly targeted by the expansion refusals, but they are not the only ones. Minority groups will also be unduly hurt by the rejected Medicaid reform, as minorities represent a disproportionately large percentage of the uninsured population. Hispanics, for example, represent 30 percent of the uninsured, but only 14 percent of the total U.S. population. A Kaiser Family Foundation study reports that racial and ethnic disparities in access to health care will be significantly reduced in states accepting increases in Medicaid funding. Thus, the states opting out of the expansion are not only threatening low-income individuals, but also discouraging minority prosperity.

Unfortunately, we've seen this behavior before. Since America's inception, states have used their legislative powers to make political decisions threatening their neediest citizens, which, historically, have disproportionately been minority group members. Federal lawmakers balk at such procedures, so states have historically resorted to the avenue of "state's rights'' as a mechanism to propagate policies that range from neglectful to discriminatory.


Take 1890: In defiance of the federal abolishment of slavery, 10 former Confederate states disenfranchised African-Americans with a "separate but equal" designation. More currently, consider 2011. Frustrated with the lack of federal progress on immigration, Arizona enacted "immigration laws" that effectively legalized racial profiling under the pretense of "reasonable suspicion," infringing upon the civil rights of minorities across the state.

Today, the 14 states refusing to expand Medicaid are perpetuating this trend by withholding health care coverage from their poorest residents, a group disproportionately comprised of minorities. Whether this discrimination is purposeful or an unintended side-effect of the decision is unimportant. The consequences for low-income individuals and minority group members will be grave either way.

The financial implications of the expansion render the 14 states' motives in this decision even more dubious. The Medicaid expansion will be 100 percent funded by the federal government through 2017, and 90 percent after 2020. Moreover, a Kaiser Family Foundation study estimates that Medicaid expansion would actually save states a total of $10 billion from 2013-2022, mainly due to a sharp reduction in uncompensated care costs. Even Republican governor Chris Christie, a fervent opponent of the Affordable Care Act from the start, was forced to admit that the changes to Medicaid make financial sense for states when he accepted the expansion for New Jersey on Feb. 26.

In the face of these numbers, the refusal of 14 states to expand Medicaid is exposed as sheer partisan gamesmanship, and, this time, there are real victims: low-income individuals and minorities who are deprived of health coverage as a result of their governors' frivolity. This result makes clear that the time for partisanship at the expense of the uninsured has ended. When it comes to health care, states must start providing for their neediest citizens instead of surreptitiously looking away, afraid of what they will see.

In 2013, the ignorance card is no longer in play; the willingness of 14 governors to look past the discriminatory repercussions of their Medicaid expansion refusal is unacceptable. Health care is no longer a red state-blue state issue; it is a right. The Affordable Care Act has mandated that America's health care system must responsibly care for every group, regardless of class, race, or income. Expanding Medicaid is the chance for every state in the union to show that it believes in this ideal.

Rachel MacLean is a junior at Williams College. She has an interest in health policy, while majoring in political economy and Chinese.


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