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May 12, 2014 9:38 AM Cost of the Medicaid Expansion Rejection in Lives As Well as Dollars

By Ed Kilgore

The more research that is done on the human toll of denying people health insurance, the easier it is to place a price in lives as well as dollars of decisions like that made by nearly half the states to reject the Medicaid expansion provided for in the Affordable Care Act. At Politico Magazine (in a piece given the wonderful, Celine-esque title, “Death on the Installment Plan”) Harold Pollack of the University of Chicago utilizes the findings of last week’s study on the lives saved by RomneyCare in Massachusetts to make some suggestions for those that might be saved by making Medicaid available to more non-elderly adults:

As a matter of fiscal policy, [rejecting the Medicaid expansion] makes little sense. The federal government would initially cover 100 percent of the costs. Its share will gradually drop to 90 percent over the coming years. Over the next decade, the federal government will cover more than 95 percent of the Medicaid expansion’s total cost. Edwin Park of the Center on Budget and Policy Priorities notes that the ACA raises state expenditures on Medicaid and the Children’s Health Insurance Program (CHIP) by only 1.6 percent, when compared with what expenditures would have been in the absence of health reform.
Even the above figures overstate states’ true fiscal burden, since these federal dollars would cover many services such as mental health care, public hospital services and services to the correctional population that would otherwise be supported by states and localities. Medicaid expansion is a significant economic stimulus to the states that have adopted it. Even in deeply conservative states such as Texas, the expansion is strongly supported by the medical community, hospitals, cities and localities and other key constituencies.
Texas and other huge states like Florida are leaving tens of billions of dollars on the table. When asked to give an accounting of themselves, officials offer flimsy justifications to evade two obvious realities: First, Republican politicians do not want to embrace the centerpiece domestic policy achievement of the Obama presidency. Second, many of these same politicians display conspicuously tepid concern for the wellbeing of the expansion’s most obvious beneficiaries: poor, nonwhite, politically marginal residents of their own states….
Nearly 5 million low-income Americans are income-eligible for Medicaid under the ACA, yet live in states that now reject the Medicaid expansion. Within this rather small but critical low-income population, that same one-per-830 estimate [made in the Massachusetts study] implies that almost 5,800 people will die every year as a result of being left uninsured. That’s only an estimate. It may overestimate—or underestimate—the true human consequences. In my view, there’s no escaping the fact that partisan opposition to the ACA is costing thousands of actual human lives every year.

That’s a hell of a toll for scoring an ideological point.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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