Obamacare’s good Rx: Republican-leaning states wake up to the value of expanding Medicaid eligibility

If only politicians had to recite the Hippocratic oath. Instead, some do what’s best for the well-being of the people they represent while others continue to reject the best evidence and serve their own narrow ideological and partisan ends.

Since the passage of the Affordable Care Act in March 2010, states have taken advantage of a core provision expanding Medicaid, almost entirely on Washington’s dime, to adults with incomes of up to 138% of the federal poverty level. That works out to about $20,120 for an individual and $41,400 for a four-person household.

To date, 40 states, including many with Republican-dominated legislatures, have bought into the Medicaid expansion. They include Ohio, Idaho, Utah, West Virginia, Louisiana, Missouri, Oklahoma, Montana and Alaska — some of which have taken the plunge via popular referendum. Monday, North Carolina became the latest state to join in, in this case after action by its Republican-dominated legislature and Democratic governor.

Good going: In states that have expanded Medicaid eligibility, just 6.6% of people are uninsured; in holdout states, 12% are. Expansion states also report better health outcomes and more progress in reducing medical debts. Researchers connected with the National Bureau of Economic Research in 2021 estimated that over the course of one four-year period, 19,200 more adults aged 55 to 64 survived as a result of the expanded coverage.

Health care in America is no picnic; life expectancy is dropping, and maternal mortality rates are rising, especially among Black women, and the cost of care keeps stressing family budgets, to name just three depressing vital signs. But in the 10 Medicaid-expansion holdout states — Texas, Florida, Alabama, Georgia, South Carolina, Tennessee, Mississippi, Wyoming, Kansas and Wisconsin — many conditions are especially grim. Rural hospitals that serve low-income Americans are in full-blown crisis, with Black people bearing the brunt of it.

The path to longer, healthier lives starts with broader coverage via Medicaid expansion. Thirteen years after its passage, it’s long past time to stop using Obamacare as a political attack line and start using it as a lifeline.

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