April 13, 2013

Southern states fight Medicaid growth

Governors decry the growth of government programs but are considering a private solution.

By TONY PUGH McClatchy Newspapers

BILOXI, Miss. - Michael White's high blood pressure is acting up again.

Problems Medicaid users face in the south
click image to enlarge

Coastal Mississippi residents wait in line outside the Bethel Free Health Clinic in Biloxi, Miss., on March 19 in order to be one of the dozen or so that will be seen by the volunteer staff. The clinic opened following Hurricane Katrina and continues to provide services.

Amanda McCoy/Biloxi Sun Herald/MCT

The 51-year-old casino janitor has recurring seizures and recently awoke in an ambulance after passing out at a bus stop.

"It doesn't hit me suddenly," White said. "It creeps up on me. I get this feeling like I'm outside of my own body."

If White had insurance, he'd be under the care of a primary physician and taking medications regularly. But he can't afford job-based health insurance on his $8-an-hour wage and he earns too much to qualify for Medicaid, the state-federal health plan for poor people and those with disabilities.

So White takes his place in a growing line of uninsured patients outside the Bethel Free Health Clinic on the grounds of a federal housing project in Biloxi, Miss. It's his off day, so he's in no rush. He just wants to be one of the dozen or so patients lucky enough to see a doctor.

White is one of 300,000 Mississippians who'd likely qualify for Medicaid next year when the health care overhaul extends coverage to adults who earn up to 138 percent of the federal poverty level. That's nearly $16,000 a year for an individual in 2013, or roughly $32,500 for a family of four.

But Mississippi and eight other Southern states, all led by Republican governors, have decided not to implement the Medicaid expansion, even though the federal government has pledged to pay all medical costs for the newly eligible enrollees in 2014, 2015 and 2016 and no less than 90 percent of their costs thereafter.

All of them -- Tennessee, North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, Texas and Oklahoma -- say they can't afford it under those terms.

The wall of Southern opposition is one of the last major obstacles to President Obama's goal of universal health coverage for all Americans. If it remains intact, nearly 5 million of the newly eligible won't have Medicaid coverage in 2022, according to estimates by the nonpartisan Kaiser Family Foundation, a health care research group.

Besides shared borders and conservative political leadership, most of the nine states have something else in common: By a host of measures -- from obesity to infant mortality -- all but North Carolina and Georgia are among the unhealthiest in the nation, according to the 2012 edition of America's Health Rankings.

High poverty typically has dragged down the Southern rankings. So have risky health choices, such as poor diet and smoking. But so can the impact of public policy decisions, such as whether the social benefits of the Medicaid expansion are worth the costs.

A new report by the philanthropic Robert Wood Johnson Foundation finds the nine anti-expansion Southern states among the 21 that would benefit most from broader Medicaid eligibility, based on their higher levels of working poor adults who struggle with medical bills.

"I think it's very foolish from a health perspective, from an economic perspective, for these states to be turning this down," said Joan Alker, a co-executive director of the Center for Children and Families at Georgetown University. "It's playing politics in the worst sense of the word. There are no big interests that are against this. The hospitals are for it. The managed care industry is for it. Most of the employer groups are for it. The opposition is purely ideological. It's the tea party faction of the Republican Party."

The nine Southern anti-expansion states aren't the only opponents. Republican governors in six other states -- Maine, Pennsylvania, Michigan, South Dakota, Iowa and Idaho -- have said they won't participate, either, although pressure is mounting for them to reconsider.

(Continued on page 2)

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