All day Tuesday there were a series of quasi-political events scheduled in Columbia, the state capital of South Carolina. Health care advocacy groups made up the majority of the activists that called a morning news conference, held afternoon training sessions and conducted an early-evening public forum featuring Robert Greenwald, the director of the Harvard Center for Health Law and Policy Innovation. The activists were calling attention to Governor Nikki Haley’s decision to reject the option to expand the state’s Medicaid program. The purpose of the daylong focus on Haley’s action was to reach state legislators and persuade them to statutorily override a move that could prove very counterproductive to the state’s health care interests.
The opt-out clause was part of the ‘fine print’ in the Supreme Court’s National Federation of Independent Business v. Sebelius decision last June, a ruling roundly applauded by progressives because it appeared to uphold the Patient Protection and Affordable Care Act in declaring its mandate constitutional as a tax (but not acceptable under the commerce clause). That’s great up to the point that ACA calls for expanded Medicaid coverage for all non-seniors with incomes lower than the 133% of the poverty line. That’s roughly $15,000 and below. And you can be assured folks working for that amount have nothing resembling health insurance. Incidentally, 15 grand is weeks take for somebody in the $780,000 annual earnings range.
However, in including the opt-out clause in its decision, the court gave the states the choice of either taking their own sweet time in its adoption or telling millions of people in desperate need of funding for serious health conditions to go to hell. The latter turned out to be the popular Republican choice. It took Haley all of a week back in early July to make her decision. South Carolina alone has an estimated quarter of a million people who would be expected to sign up for Medicaid expansion.
I’m sure you’ll not be even remotely surprised at the roster of right-wing governors who share Haley’s hatred of the feds and therefore have chosen to opt-out as well. Do the names Jindal, Scott, Perry and Walker ring a bell? Add Republican gubernatorial Neanderthals from Oklahoma, Iowa and South Dakota to the list (at latest count) and you have the funeral home directors of opt-out states cheering at the top of their collective lungs because their businesses stand to benefit mightily.
There’s no question about it, in many cases withholding these funds will result in death. A real life example: I know a fellow who has a severe heart condition. He could barely walk a quarter of a block without being rendered breathless. He was scheduled to be placed on the heart transplant list. To live long enough to receive a transplant, he would need the duo implants of a pacemaker and something called an Implantable Cardioverter Defibrillator. His state had dallied around with his application for so long that he still didn’t have Medicaid (even though declared 100% disabled) after many, many months of phone calls, emails and paperwork. These unconscionable delays are another obscenity that needs to be addressed.
My friend was admitted to a hospital a few months ago with uncontrolled ventricular fibrillation. Each breath he took, was agony. Still, the heart surgeons refused to operate without Medicaid coverage for the patient. As this gentleman was IV-dripped into a fog and lay dying in the ICU, his Medicaid finally came through and the surgery was performed early the next day. He not only lived, but his condition improved dramatically. He’s now walking fair distances and breathing normally, however bionic his heart may be.
But the red state extremist politicians don’t care whether people die or not. And it’s not only the question of Medicaid expansion. MSNBC’s Al Sharpton, on his show PoliticsNation, passed along the fact that work-place fatalities in Right-to-Work states are 53% higher than in non-RTW states. Clearly, elected right-wingers are a one party death panel.
The expansion option doesn’t officially begin until January 1, 2014, but a state can sign on early if so inclined and five states and the District of Columbia (all blue of course) have done so. This, in spite of the fact that the feds only pay the current match level of 50%. By the 2014 start date these states will have already signed up 600,000 people for expanded coverage. One of those states, California let’s the counties decide if they want to go the full 133% or somewhat less.
The first 3 years of the expansion, 2014-2016 are paid in full by the fed. States then gradually pay incrementally more as their share until state contributions peak at 10% in 2022 and remain there. The government then covers 90% annually.
The recalcitrant states will say it’s all about money. In a way they’re right. Refusal to participate leaves roughly $3 billion of that money on the table in South Carolina. The South Carolina Hospital Association citing a study by the University of South Carolina Moore School of Business estimates the economic impact of Medicaid expansion would create nearly 44,000 jobs in the next 7 years. The $11.2 billion in federal spending over that same time period would generate nearly $644 million in state revenues; more than enough to cover the state’s contribution to the program.
Absent the expansion, people in the expansion window will still go to hospitals. Depending on the doctors, many will die, when they could have lived (see above). Those who are treated will be by and large charity cases. And that lost revenue will have to be made up somewhere. That’s where you come in kemosabe.
The Chairman of the South Carolina Hospital Association Board of Trustees who is also the CEO of Palmetto Health summed up the case for adoption of the expansion best, “There is a strong economic case for expansion, coupled with an important health benefit to the newly enrolled. Having health insurance makes a difference for individuals and families, and these benefits are shared by the business community through a strong, healthy workforce.”
Can I have an “Amen?”