The human faces of the Medicaid debate

When Red States 'just say never' to ACA's Medicaid expansion, millions of poor and sick facing disability, chronic illness pay the price


This is the punch-in-the-gut opening of Robert Pear’s article in today’s New York Times:

Brenda B. Culick has two stents in her heart and a severe wound in her right leg, injured while she was doing home repairs six months ago. But she cannot afford to see a cardiologist or go to a wound care center.

Her household income is $1,200 a month, but she does not qualify for Medicaid because she has no dependent children and is not disabled. Ms. Culick, 52, is one of several hundred thousand people left behind by South Carolina’s refusal to expand Medicaid under President Obama’s health care law – a choice made by about half the states.

“If I could get Medicaid, I’d be the happiest person on earth,” Ms. Culick said.

You might think this is a cherry-picked example. It isn’t. I’ve found that roughly four million Americans suffer the dual challenge of being uninsured and suffering from disability or chronic illness. Many live in poverty, and they need basic Medicaid coverage. Unfortunately, many live in red states which adamently refuse to accept virtually free federal funds to help.

Every day, people who are poor and sick pay the price. There’s a legitimate epidemiological debate regarding just how many thousand of Americans die every year because they are uninsured. When you consider what this woman must be going through, you realize how sad it is that we’re even having the discussion.

If Ms. Culick provides one human face of the issue, South Carolina governor Nikki Haley provides another. Her extreme approach to governing has included near-Dickensian cuts to Meals on Wheels, hospice care, and other services.

In her State of the State speech in January, Gov. Nikki R. Haley, a Republican, said, “South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.” And she boasted of her stance at a recent rally announcing her bid for re-election. “When it came to Obamacare,” she said, “we didn’t just say ‘no,’ we said ‘never.'”

Such comments have rather unfortunate historical resonance, particularly when one considers the demographic and political reality that so many South Carolinians who need Medicaid are African-American, as Joyce Barr, another woman profiled, happens to be. Ms. Culick, who is white, suffers from some of the same policies disfigured by her state’s history of divisive racial politics.

Of course, health policy is complicated. Some states are looking to alter details of Medicaid expansion to match local preferences and local needs. Such negotiation is part of the normal and appropriate process of implementing a new law. The Obama administration is wise to be flexible. Republican governors need a dignified path to taking the funds.

Then there are places like South Carolina, whose leaders simply reject billions of dollars in federal help that could assist some of the most vulnerable men and women in America. I hope people read Mr. Pear’s judicious report, and that they are properly disgusted by it.

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