Expanding Medicaid Helps Rural America---N.Carolina

Just Signed Up, But When Will Mississippi?

April 2023 - One of the major features of the Affordable Care Act (ACA) tended to be overlooked when Congress enacted the ACA in 2010, but we're pleased to report that North Carolina now has become the 40th state to take advantage of the financial benefits associated with that aspect of the law.

That feature of the ACA, and those benefits, are the significant amount of extra funding the federal government will provide to states that expand their Medicaid program to include additional low income Citizens, millions of whom live in rural parts of the country. {As a reminder, Medicaid is a jointly funded partnership of the state and federal governments that provides healthcare coverage to low income Americans not covered by workplace health insurance.}

On average, the federal government contributes about 60% of the cost for existing Medicaid enrollees. But the ACA boosts the federal government's share of Medicaid funding to 90% of the additional cost incurred by any state that expands its Medicaid coverage. That expansion would apply to those non-elderly adults whose income is less than 138% of the federal poverty level.

{Gov. Roy Cooper of NC has supported Medicaid expansion since taking office in 2017 - image from ncpolicywatch.com)

Not only would these additional dollars provide health care benefits to millions of uninsured Americans, they would provide the necessary funding that would allow many rural hospitals to remain open and, consequently, would allow more medical professionals to continue practicing in rural areas of our nation. It's no secret that a healthcare crisis is brewing in rural America where hospitals and medical centers are closing and where shortages of doctors and healthcare workers are limiting Citizens' healthcare options.

Louisiana, where Governor John Bel Edwards expanded Medicaid shortly after he took office, is a good example of the benefits accruing to Medicaid expansion. It was estimated that Louisiana would receive $16 billion of federal funding over the next ten years, which would provide healthcare coverage for at least 300,000 Citizens of the state and also would create 15,000 jobs in just the first two years.

In our mind, then, it was surprising to hear that not only had North Carolina held out on Medicaid expansion until last month, but that ten other states still have not taken advantage of the ACA's Medicaid expansion provisions.

So why is it that states like Mississippi, Florida, and Texas haven't signed up yet?

{Unlike the current governor, gubernatorial candidate Brandon Presley supports Medicaid expansion - image from brandonpresley.com)

Unfortunately, it comes down to politics. Early on, too many conservatives had decided that because the ACA had been supported by President Obama, they weren't going to acknowledge there was anything good at all about the ACA, even if by doing so they were hurting their own Citizens and their own states' economies. So, initially, virtually no states with Republican Governors and legislatures would even consider participating.

Over time, however, some Republican legislatures have grudgingly begun to change their minds, although do you notice something interesting in the following examples from Republican-leaning states:

Alaska, Montana, Ohio, Louisiana, and North Carolina all voted twice for Donald Trump and all have large Republican majorities in their legislatures (which is the result of gerrymandering, but that's a story for another day). However, the Governors of those five states at the time of their Medicaid expansion were an Independent, a Democrat, an anti-Trump (but pro-Reagan) Republican, a Democrat, and a Democrat, respectively.

Here are three other interesting examples of Medicaid expansion, this time in more heavily Republican states:

Idaho, South Dakota, and Oklahoma also voted for Mr. Trump twice but, in order to expand Medicaid, the Citizens in each of those states took the matter in their own hands and voted in favor of expansion via statewide referendums (that were put on the ballot with strong medical community and Democratic support.)

{image from npr)

These ballot measures were required because the far right Republican Governors and legislatures in those states would not expand Medicaid themselves. Those GOP officials also were strongly opposed to the ballot proposal; fortunately, that opposition did not appear to influence the voices of the states' Citizens.

In other words, it seems that it usually took Democratic or Independent-minded Governors, or the will of the people to make the smart decision and vote to expand Medicaid.

Unfortunately, the Republican Governors and legislatures in Mississippi, Texas, Florida, and the other seven states that still have not approved Medicaid expansion, are so dug in with their anti-ACA position they probably never will budge.

We suspect many of those officials probably know their position is wrong, though. For example, there are stories circulating that Governor Tate Reeves of Mississippi privately has acknowledged he thinks Medicaid expansion would be a good thing; he just can't support it for political reasons.

If that story is true, it's another black eye for Mississippi and another reason we hope the good Citizens of the Magnolia State support Brandon Presley in this year's Governor's race.

{Brandon Presley image from tippahnews.com)