Although the United States has a checkered record when it comes to dealing with its poorest and most disadvantaged populations, the South is the unabashed leader in that category. I won't get into the history, as it is well-known. But it is clear that the region's traditional resistance against social progress is now being acted out through its refusal to expand Medicaid coverage under the Affordable Care Act (ACA).
Two dozen states have refused to expand Medicaid, but outside the South, they are mostly scattered across the country. The region itself is in complete lockstep on the issue.
It is conduct that will not only leave hundreds of billions of dollars on the table that the poorest states could use to provide healthcare to its poorest citizens, but also causes hospitals to close. All the while, Southern lawmakers have essentially covered their ears with their palms shouting "la-la-la-la-la-la-la" while the region's hospitals are squeezed by the ACA's cuts in disproportionate share hospital program payments.
Their arguments for not expanding Medicaid, as I have noted here before, verge on the absurd. The most enduring one is the fear that there won't be funding for Medicaid expansion in the future, although the only people who aim to cut the program are lawmakers like themselves. The Urban Institute went so far as to debunk that notion in a recent report, noting that only once in the past 33 years has the federal government cut its funding to the states.
Nevertheless, there is North Carolina, which has decided to tinker with privatizing its existing Medicaid program. And South Carolina, which recently decided to free up some $15 million to give to hospitals to try and make them more competitive. The obvious solution is utterly ignored.
This reminds me of the memorable phrase "we have met the enemy and he is us," from the classic comic strip "Pogo." That the title character spoke those words in the South's Okefenokee Swamp seems altogether fitting and proper.
I will concede that not every Southern politician is against Medicaid expansion. Florida Gov. Rick Scott supports it, but the attempts he has made to get lawmakers on his side have been feeble at best. Contrast this to Southern border states such as Kentucky and West Virginia, with GOP-controlled statehouses but Democratic governors. Both were able to expand Medicaid. In West Virginia, home to some of the most grinding poverty in the nation, the uninsured rate promptly dropped by a third.
And I will note there has not been a single politician turned out of office for supporting Medicaid expansion.
However, it is clear that there are few elected officials in the South who have the moral courage to stand up and resist the will of their loudest constituents, making them little different from the clerk who sits idle in his or her cubicle all day while giving the appearance of being busy. They're scared of losing their jobs, but do not want to make any waves by performing it in a way that will garner the wrong kind of attention.
The problem is, elected officials are not clerks. They are supposed to be leaders, more concerned with the improvements they make and the legacy they leave behind rather than surviving another election campaign. Granted, this is a naïve position to take, given politics is and always is a popularity contest.
But the Southern states hover near the bottom of virtually every indicator of good health and near the top of every indicator for poverty. Their politicians have the moral obligation to note to the voters whenever possible that their states remain the last patch of the industrialized world that does not guarantee healthcare to its least fortunate citizens. The South being the South, I imagine many would take pride in that fact. But maybe it would get a few more to change their minds. - Ron(@FierceHealth)
