The continued resistance to Medicaid expansion is silly and profoundly damaging

I recently journeyed to England and one impression that will stick with me is that the United Kingdom is paying closer attention to what goes on within its borders than the U.S. is within its own.

When I wasn't covering my eyes in Northern England from the terror of having to drive the wrong way, I could not help but notice the pristine condition in which the nation maintains its major highways and backcountry roads. The 180-mile train trip down to London was whisper silent, took less than two hours and cost the equivalent of $63 for my entire family. I lost count of the solar panels and wind turbines we passed during that trip.

The British Parliament also recently evicted a lawmaker for a day when he called Prime Minister David Cameron "dodgy" and refused the House of Commons Speaker's request to "withdraw that adjective." I turned on the television earlier today to Presidential candidate Donald Trump discussing at length how Ohio Gov. John Kasich eats pancakes. "It's disgusting. Do you want that for your president?" he asked.

While its debatable whether his gustatory habits are critique-worthy, Kasich has done something decidedly not disgusting during his first term as governor: He expanded Medicaid eligibility under the Affordable Care Act (ACA), one of the few Republican governors to do so. As an observant Christian, he said it was the right thing to do.

Six years after the ACA became the law of the land, it is evident that it did not destroy the nation. But 18 states remarkably have yet to expand Medicaid. Some undertook expansion as soon as a key figure exited office, such as Gov. Bobby Jindal in Louisiana. Maine, the only northeastern state not to undertake expansion, will likely do so the second Gov. Paul LePage exits. But others, like Mississippi and Texas, may never do so. The former is the poorest state in the union; the latter has the highest rate of uninsured. It's virtually impossible for a poor adult in either state to obtain coverage. Meanwhile, states whose leadership decided to expand Medicaid by the skin of its teeth may yet teeter back into repeal, as is the case with Arkansas and Kentucky.

The reasons for not expanding Medicaid are mostly political--voters are convinced that either the ACA is evil or that poor people who receive care without paying for it are stealing. There are few politicians with the courage to challenge that wisdom, such as it is. But other than getting them re-elected, that stance achieves little but damage their constituents and their hospitals. Among the fallout:

  • Many rural hospitals, already under fiscal pressure, desperately need the extra dollars to keep their doors open. Some have had their closures hastened due to the lack of expansion.

  • A new study by the Bureau of Economic Research concludes that Medicaid expansion has helped cut the medical debt of low-income patients by as much as $1,000 a year. Given medical debt is the leading cause of bankruptcy in this country, that is a significant achievement.

  • Suicide rates have been climbing steadily in the U.S. in recent decades, with those between the ages of 45 and 64 seeing huge jumps--63 percent for women and 43 percent for men, respectively. Those who lack an advanced education and the income that comes with it are particularly vulnerable. "This is part of the larger emerging pattern of evidence of the links between poverty, hopelessness and health," Robert D. Putnam, a professor of public policy at Harvard University, recently told The New York Times

Despite all the evidence that expanding Medicaid eligibility nationwide is the right thing to do, it likely will never come to fruition. Instead, the country will obsess over doing something "huge," building a wall and other external issues that are more noise than necessity.

The U.K. is certainly not perfect; it struggles with a variety of social issues. But the country that birthed us doesn't squabble over whether it is right for the poor to face financial ruin if they need healthcare--access has been universal for decades now.

We may yet get there one day. But it won't be without a lot more bloody kicking and screaming. --Ron (@FierceHealth)

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