A White House report has indicated that 24 state legislatures chose not to opt into the Obamacare Medicaid expansion this year, implying an ongoing GOP resistance that Southern Catholic leaders fear will hurt the working poor.
According to the report, relesed on July 2, only 26 state legislatures have so far opted into the Affordable Care Act’s offer of financial assistance for states that expand Medicaid coverage to include non-elderly family members whose incomes are below 133 percent of the federal poverty level.
In June 2012, the U.S. Supreme Court ruled that states may opt out of Medicaid expansion. The 2014 legislative session is the second straight year in which states have had this opt-out option.
The 24 legislatures that decided for the second straight year not to expand Medicaid include all five Gulf South states of Louisiana, Alabama, Florida, Georgia, Mississippi and Texas—all places where Catholic bishops came out publicly in support of expansion. The White House report warns that these states will forgo “billions in federal dollars that could boost their economies” by creating jobs in the health care industry.
With most state legislatures now finished with their work for the year, some Catholic officials in the Gulf South noted Wednesday that Republican lawmakers had blocked expansion as a way of resisting Obamacare in general—a strategy that Catholic health care advocates believe will have negative effects on the unemployed and underemployed.
Rob Tasman, director of the Louisiana Conference of Catholic Bishops, said Republican Governor Bobby Jindal—a Catholic—had torpedoed the bill in his state by signaling to lawmakers that he would not sign a bill promoting any form of Obamacare. “Our bishops came out very strongly for Medicaid expansion without any hesitation because it so clearly helped the working poor,” Tasman told America. “But many legislators were confused about how they could oppose the [Department of Health and Human Services' contraception] mandate and support the Medicaid expansion at the same time. I think partisan rhetoric saying that every part of Obamacare was wrong had a lot to do with it.”
Tasman added, “It’s a challenging and frustrating process to not have any movement on something that could have helped hundreds of thousands of people in the state of Louisiana.”
He noted that Medicaid currently covers prescription medicines for children and families, but adults without children are not covered, a population that includes many of the homeless in addition to the unemployed and marginally employed.
“If we don’t accept Medicaid expansion, people are going to die,” Tasman said. “That’s why it’s a pro-life issue for us just as much as the H.H.S. mandate is a pro-life issue.”
Father Fred Kammer, S.J., director of the Jesuit Social Research Institute (J.S.R.I.) at Loyola University New Orleans, said the loss of fiscal and health benefits to Louisiana would be significant.
“What adds to the shock about the rejection of Medicaid expansion in the South is that we are the poorest states, with the poorest health outcomes—which undermine people’s ability to work—and we turn away both significant economic enhancements and a chance to help our working poor citizens simply out of political spite,” Father Kammer told America.
“In Louisiana, the added tragedy is that the governor is well versed in the realities of health care financing, knows the benefits of Medicaid to the working poor and is putting his own political aspirations ahead of his moral duty to the people of the state."
According to a J.S.R.I. report published last winter, 18 percent of the nation’s population—47,311,500—are uninsured. Of these, 12,013,900 live in the Gulf South, 25.4 percent of the nation’s uninsured. More than half of all uninsured Americans, or 52 percent, are black or Hispanic. The J.S.R.I. report noted that 22 percent of the people who reside in Louisiana—866,200—are uninsured. It added that 27 percent of Texans are uninsured, 25 percent of those who live in Florida, 18 percent of those living in Mississippi, and 16 percent of those in Alabama.
Dr. Elmore Rigamer, mental health services director for Catholic Charities New Orleans and a public health instructor, said the impact of not having Medicaid in Louisiana is especially deep because of the state's low quality-of-life indicators. “It’s terrible because we have one of the highest rates of uninsured people with chronic diseases like diabetes, hypertension, asthma, heart problems,” Dr. Rigamer said. “It’s killing us because we have one of the poorest literacy and poverty rates. When you’re working two or three jobs, but you don’t have money for medication at the pharmacy, you get sicker and lose your job. It’s very sad.”
Michael Sheedy, director of the Florida Conference of Catholic Bishops, told America that Florida’s decision to opt out of Medicaid expansion was a missed opportunity for his state as well. “We’ve had two years of missed opportunities,” Sheedy said. “Obviously, we support Medicaid expansion, and I think the White House report highlights a number of jobs that have been lost in states which are not expanding Medicaid coverage. Tens of thousands of jobs have been lost in Florida.”
In 2013, Sheedy noted that leaders in the Florida senate were open to using federal funding for managed care plans, and there was some openness in the governor’s office. But strong opposition in the Florida house caused the political winds to shift.
In 2014, Sheedy said the Obama administration’s decision to delay penalties included in the Affordable Care Act for employers who fail to provide affordable health care played a role in defeating a renewed push for Medicaid expansion.
“While we regret the missed opportunities, we look forward to working with the legislature and leaders in Florida to expand coverage to the poor and otherwise vulnerable next year," Sheedy said.
In Florida, Republican Governor Rick Scott has argued that the state would lose billions of dollars by expanding Medicaid, despite a Georgetown University study in January 2013 that suggested the state would save money.
Jack Hoadley, senior researcher at the Georgetown Health Policy Institute, told the Miami Herald on Jan. 31, 2013, that spinoff savings in other state programs over the next decade could bring $26 billion in federal insurance money to Floridians living without health insurance.
In the capital of Mississippi, Greg Patin, director of Catholic Charities for the Diocese of Jackson, told America that the Mississippi legislature’s decision to opt out was driven by fears that the financial windfall would actually be much lower than these sorts of studies suggest. “We see Medicaid as a real human need, but the powers that be in Mississippi don’t feel like the federal dollars are secure enough,” Patin said.
“Unfortunately, we have not been on the winning side of this issue. It does have a very negative impact on the working poor. We’re talking about people working two or three part-time jobs who cannot afford health care. These are people working at McDonalds, Walmart, and at hairstyling salons.”
Patin added that Medicaid expansion could have provided substantial health care jobs in the state of Missisippi. “The loss of the disproportionate share money is really going to affect our rural hospitals, which are already closing beds and services in our very rural state,” he said.
Catholic bishops in Alabama, Georgia, and Texas have expressed similar concerns. In a letter to Republican Governor Rick Perry last year, the Texas bishops argued that "we need to draw back for the benefit of Texans the tax dollars that Texans send to Washington. Otherwise, other states will use our nation’s tax dollars to expand their Medicaid programs, while we continue to pay higher local taxes and insurance premiums to provide for uncompensated care."
Catholic leaders in the Gulf South are expected to renew their support for Medicaid expansion in the 2015 state legislative sessions.
Sean Salai, S.J., is a summer editorial intern at America.
