A Medical Emergency: When States Opt Out of Providing Care
This past May, the Republican-controlled legislature in Missouri voted to opt out of the federal government’s upcoming Medicaid expansion. This decision is not unique to Missouri—25 other states have opted out as well, claiming that the increased tax burden of a Medicaid expansion outweighs its benefits. The majority of states that rejected Medicaid are poor, southern states with large numbers of people who need better coverage and who would benefit from the expansion most. In fact, the choice not to expand will preclude over half of the nation’s low-wage workers and roughly two-thirds of poor blacks and single mothers from obtaining adequate health insurance. So why are the states that need Medicaid the most the ones opting out?
The answer revolves around the conservative politicians who have been largely responsible for garnering opposition to Obamacare: essentially, they claim that an expansion of Medicaid would not be cost effective, that the increase in taxes would outweigh the benefit of providing millions with health insurance. This argument cropped up many times in the states’ discussions about Medicaid, including Missouri’s, where Republicans claim that coverage is generally good and that the tax burden of Medicaid would hurt poor families more than it would help them. In some states, this argument is almost justifiable. In Mississippi, for example, under the Medicaid expansion, one-third of the state’s population would be eligible for coverage according to The New York Times. Republicans claim that this would drastically increase taxes, which is true. However, for the first three years of the Medicaid expansion the federal government would fund it in its entirety, and after those three years, states would only have to fund ten percent. This ten percent, Republicans claim, is too much.
It is true that funding ten percent of Medicaid in states like Mississippi would require a hefty sum of money, but the benefits far outweigh the costs. The bulk of these benefits come in the form of federal money that goes to the previously uninsured. A study of fourteen states by the Rand Corporation, a think tank, found that by forgoing Medicaid expansion the states are effectively losing $8.4 billion of Medicaid funding over three years and assuming roughly $1 billion of costs for those who currently provide healthcare to the indigent. The same study estimates that the cost of expansions is less than the cost of assuming uncompensated care, which is the cost that the hospitals must assume if their patrons do not have health insurance and cannot pay for their healthcare. This Medicaid expansion is a win-win for states because it increases medical coverage and reduces costs. In Missouri, for example, Medicare would cover 800,000 additional people. But increased medical care would not only be beneficial to our surrounding area—it would help nationwide.
Ultimately then, the claims of the politicians who attempt to stop the expansion of Medicaid make little sense because the economic and health benefits far outweigh the costs. Mainly, their objections to Medicaid are symbolic. They see the federal government’s extension of Medicaid as fundamentally bad because it raises taxes and increases the size of the government. It is inevitable that expanding government-subsidized health insurance programs will increase the size of the government, so if politicians wish to make symbolic gestures or profess their disapproval of Obama they should choose a different method. At the end of the day, sacrificing peoples’ health insurance for a political agenda is not justifiable because the politicians in Washington aren’t losing out—in the end, the losers are the poor who cannot afford health insurance, the constituents of the politicians who oppose expanding Medicaid.