When the Affordable Care Act was passed in 2010, a key element was for people who made less than 133% of the poverty limit based on their family size. This group would pay no premiums through a state-by-state expansion of Medicaid. The federal government said it would reimburse each state for 90% of that cost.
At this point in 2022, there are twelve holdout states that have not expanded Medicaid. That leaves 2 million Americans with access to no healthcare coverage. The holdout states include my home state of North Carolina and big states like Texas, Florida and Georgia (see link below to a NPR article).
North Carolina was close to passing Medicaid expansion, but the effort stalled once again. Here is a letter I sent to my newspaper that they graciously printed this morning.
NC and Medicaid
“As a retired benefits consultant and former benefits manager for a Fortune 500 company, I was hopeful that the N.C. General Assembly would at long last pass an expansion of Medicaid to fully comply with the Affordable Care Act. Failing to do this has harmed N.C. residents. Our economy has been impacted and some rural hospitals have either closed or are in financial trouble, according to the Commonwealth Fund, a nonpartisan healthcare advisor.
As former GOP presidential candidate and Ohio governor John Kasich noted when Ohio expanded Medicaid years ago, it was a no-brainer with the federal funding the state has realized for years now. Please move forward on Medicaid expansion.“
We have heard of food deserts in largely rural states which impact people in need more than others. But, we also have healthcare deserts as well. Taking only one data point, it is not a surprise to learn that maternal mortality rates in these states are worse than in other states and first-world countries. Note, this is mother’s dying in childbirth. That is a sad state of affairs, especially for a country who claims exceptionalism.
musingsofanoldfart 
Hello Keith. Grand letter and great points. While I think the ACA is a good step towards universal healthcare coverage, I disagree with it because it is a source of income for insurance agencies, as long as the government pays up. Adding a middleman always increases the price as it is one more point that needs profit. Having said that I am grateful for it, because for about year I was without insurance and high medical needs without an income. I was able to get the medical care I needed with coverage costing me about $26 dollars a month. Hugs
Scottie, true but I think they did that to not drive agents out of business. Yet, you can actually sign up without an agent. Keith
Hello Keith. It is a good point that if some type of universal medical care were implemented a lot of middle men such as insurance companies / agents would be out of a job. But did that stop the automotive industry because the buggy whip industry would be put out of business? Or even the wagon makers? With every advancement in society there are those things of the past that become obsolete. Hugs
Scottie, I agree a more universal coverage model would be more beneficial, but the healthcare industrial complex is powerful and would prevent it from happening. Keith
There this correlation of health statistics with political red vs blue striping. Amendment: direct election of potus.
Bumba, to your point, I read a report where red states who did not expand Medicaid have worse healthcare outcomes than states that did. That would include medical debt where 100 million Americans have a medical debt issue, with only 42 million have college debt. Keith
Note to Readers: Per an article on June 10, 2022 in Salon,
“The red-blue divide in American politics extends beyond culture and mask-wearing habits, but also to health. Indeed, residents of Democrat-leaning counties are seeing fewer premature deaths than in counties that vote consistently for Republicans.
That’s according to new research from Brigham and Women’s Hospital, which found specifically that, over the last two decades, a widening gap in mortality rates has been observed between red and blue American counties. While medical experts emphasize that across the board, mortality rates have continued to improve (despite a slight drop in life expectancy that began around 2014 and fell even further during the pandemic) counties that voted for Democrats in presidential elections from 2000 to 2016 saw a faster decline in premature deaths than their Republican-leaning counterparts.”
To me, a key reason is states who did not expand Medicaid and whose ACA relative numbers are less, have worse outcomes. But, also rural health care is suffering with or without coverage due to fewer doctors, limited healthy food choices and fewer hospitals.
I’m curious as to their reasoning (beyond owning the libs)… sensical or not.
Janis, they have told everyone how bad the ACA is, so they are reluctant to say yes, even if it is a “no brainer” as John Kasich says. Here in NC, a Republican mayor begged the General Assembly to expand Medicaid to save the town’s hospital. Since they said no, the mayor walked to Washington from NC in protest, but to no avail.
The dilemma is rural hospitals have about 2/3 of their revenue for indigent care. Expanding Medicaid gets them paid. Keith
Wow… and yet they keep getting reelected.
Janis, when half of the Republican party is voting against their own economic interests and have no idea they are, it is easy to convince them something else is bad. It has been this way for decades. Keith
Reblogged this on NANMYKEL.COM and commented:
I have trouble understanding cruelty for whatevr reason.
Nan, many thanks for the reblog. It is greatly appreciated. Keith
In Idaho it took a very well organized ballot initiative to force our stupid GOP governors kicking and screaming to honor Medicaid expansion. Even after it passed with well over 60% approval by voters, the legislature still tried to do a legal end run around it. They failed. So far.
Linda, it amazes me how a legislature can try to deny something approved by voters. That happened in Florida on another ballot initiative. Keith