CW: Death
Roderick Givens, an oncologist, believes that expanding Medicaid is more than just a policy problem. He practices medicine in a rural part of the Mississippi Delta, and he meets uninsured patients every day who could benefit from Medicaid coverage.
“I can’t tell you the number of patients who I see who come in with advanced disease, who have full-time jobs,” Givens told KFF Health News. “They haven’t seen a physician in years. They can’t afford it. They don’t have coverage.”
This spring, the Mississippi Legislature discussed but ultimately failed to expand Medicaid. Medicaid expansion would have covered approximately 200,000 low-income individuals. Mississippi is one of ten states that have not expanded Medicaid.
70% of the states that haven’t expanded Medicaid are in the south. However, states like North Carolina have expanded Medicaid. Therefore, support for Medicaid expansion has “grown louder” in recent years.
Advocates for Medicaid expansion argue that resistance is mostly motivated by political division rather than economic concerns. Givens, who is also chair of the board of trustees for the Mississippi State Medical Association, which supports Medicaid expansion, stated that the federal government would pay for the large bulk of it and that most Mississippians support it.
In states that have not expanded Medicaid, hundreds of thousands of people fall into the “coverage gap,” which means they earn too much to qualify for Medicaid yet are ineligible for subsidies to help with the cost of private insurance. Those in the coverage gap cannot afford employer-sponsored insurance premiums and other out-of-pocket payments, even if they are eligible.
Coverage gaps are not a concern in states that have expanded Medicaid. In certain states, a single person earning up to 138% of the poverty line, or around $20,000 per year, can qualify for Medicaid. Someone with a higher income can qualify for private health insurance subsidies.
During the May legislative session, Mississippi’s state Senate and House of Representatives proposed Medicaid expansion for the first time. In the end, the attempts failed at the final moment. If the proposed laws had passed, approximately 74,000 Mississippians who are now in the coverage gap would have gained access to Medicaid.
Jason White, The Speaker of the House who supports expansion, acknowledged the setbacks. “It’s President Obama’s signature piece of legislation. “It’s known as Obamacare,” White said. “So, there are a lot of political dynamics centered around it that probably never allowed it to get off the ground.”
Unlike previous years, there was more support from Mississippi’s business community according to White. “I kidded some of my fellow Republicans. I said, ‘Come for the savings, if you will, and then you can stay for the salvation and the good things that it does to improve people’s lives,’” White said. “If you can’t get there because it’s the right or compassionate thing to do to help these individuals, get there because it makes sense from a business standpoint.”
This year, politics also stymied efforts to expand Medicaid in Alabama. Although the state legislature did not vote on any direct expansion proposals, an attempt was made to include expansion wording in a casino gambling bill, notably a clause directing some gambling proceeds to rural health systems. Ultimately, the Alabama plan was whittled down. The funding for rural healthcare was eliminated.
Medicaid expansion has helped more people gain access to health insurance. According to The Center on Budget and Policy Priorities, between 2013 and 2022, the uninsured rate among low-income, non-elderly people living in expansion states decreased by more than half. It decreased from 35% to 15%. It fell just slightly in non-expansion states, from 44% to 30%, leaving it twice as high as in expansion states.
Medicaid expansion also leads to better health outcomes for people. Medicaid expansion prevents the premature death of at least 19,200 adults aged 55 to 64 per year, according to a major study conducted between 2014 and 2017. In contrast, state decisions to not expand Medicaid resulted in the premature deaths of 15,600 older adults.
Medicaid expansion also increases access to healthcare services before, during, and after pregnancy, which benefits maternal and infant health. It has decreased maternal mortality, preventing almost 200 deaths in 2017 alone. Medicaid expansion is also associated with lower infant mortality.
Between 2010 and 2016, infant mortality rates decreased in both expansion and non-expansion states. However, the infant mortality rate dropped 50% more in expansion states. Racial disparities in newborn death rates decreased in expansion states as well.
Medicaid is a lifeline for millions of Americans. Medicaid expansion would help people live longer, healthier, lives. People’s health shouldn’t be more important than money.
Sources:
Constantin, Joanne, and George L. Wehby. ‘Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity’. American Journal of Preventive Medicine, vol. 64, no. 3, Mar. 2023, pp. 377–384, https://doi.org/10.1016/j.amepre.2022.09.026.
Eliason, Erica L. ‘Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality’. Women’s Health Issues, vol. 30, no. 3, Elsevier, May 2020, pp. 147–152, https://doi.org/10.1016/j.whi.2020.01.005.
“Harker , Laura, and Breanna Sharer Medicaid Expansion: Frequently Asked Questions.” Center on Budget and Policy Priorities, Center on Budget and Policy Priorities, 14 June 2024, http://www.cbpp.org/research/health/medicaid-expansion-frequently-asked-questions-0#_ftn80.
Hawkins, Drew. “The Politics Holding Back Medicaid Expansion in Some Southern States.” KFF Health News, KFF, 8 Aug. 2024, kffhealthnews.org/news/article/politics-medicaid-expansion-mississippi-south/.
Rocha, Alander. “Alabama Lawmakers Weigh Medicaid Expansion Approaches in Southern States .” Alabama Reflector, States Newsroom, 25 Apr. 2024, alabamareflector.com/2024/04/25/alabama-lawmakers-weigh-medicaid-expansion-approaches-in-southern-states/.
Rocha, Alander. “Could Gambling Money Lead to Medicaid Expansion in Alabama? .” Alabama Reflector, States Newsroom, 9 Feb. 2024, alabamareflector.com/2024/02/09/could-gambling-money-lead-to-medicaid-expansion-in-alabama/.