Friday, January 06, 2023

Given the Choice Between Free Money or Sicker Residents, Republicans Chose Sickness

Their refusal to expand Medicaid is making it impossible for rural hospitals to stay in business.

By Charles P. Pierce
ESQUIRE
PUBLISHED: JAN 4, 2023

DragonImages//Getty Images


One of the great disappointments of my political life came with the passing of the Affordable Care Act, which included FREE MONEY! for the states through the expansion of Medicaid. Then John Roberts came stumbling in and ruled that states could decline the FREE MONEY!—and almost immediately it became a point of pride for Republican governors and Republican majority state legislatures to turn down the FREE MONEY! because, you know, liberty!

Having grown up in Massachusetts, watching local and state politicians turn down FREE MONEY! from the federal government rocked my political consciousness. Heavens to Jaime Curleo, what kind of politicians were we raising these days? No respect for the classics! And that was not even to mention the fact that the FREE MONEY! would vastly improve the lives of our poorer fellow citizens because, as Adam Serwer warned us, the cruelty is the point.

Now, the proof is stacking up. Hospitals are closing by the bushel, many of them in rural areas where the healthcare facilities are few and far between. From Beckers Health Care:
"While many hospitals and health systems are facing unprecedented challenges, those faced in rural America are unique," AHA president and CEO Rick Pollack said in a statement. "We must ensure that hospitals have the support and flexibility they need to continue to be providers of critical services and access points for patients and communities."...Seventy-four percent of rural closures between 2010 and 2021 occurred in states where Medicaid expansion was not in place or had been so for less than a year.

One of those states was (inevitably) Mississippi, where now the shuttering of rural healthcare facilities has long passed the crisis stage. From the Mississippi Free Press:

“The lack of access to healthcare for many Mississippians is currently a crisis, not a new crisis, but one that has been fermenting—and is getting worse,” the Mississippi State Medical Association said in a press release this morning. “As hospitals close across Mississippi, access to life-saving medical care becomes a real threat to all Mississippi. While the debate rages on as to why our hospitals are closing, the immediate crisis progressively engulfs us.” Across the state, several hospitals have closed or cut services in recent months. During a hearing with lawmakers in November, Mississippi State Health Officer Dr. Daniel Edney warned that 38 of Mississippi’s rural hospitals, or about 54%, could close. Mississippi is already the poorest state with some of the worst health outcomes, including during the pandemic.

For years, health-care professionals, including those at MSMA, have said that the State’s refusal to expand Medicaid to more working Mississippians has contributed significantly to hospital closures. Medicaid expansion was part of former Democratic President Barack Obama’s signature healthcare law, giving states funds to expand Medicaid access to people who make too much money for traditional Medicaid, but who do not earn enough to afford private insurance and are not eligible for ACA subsidies[...]Since 2013, Mississippi’s Republican leaders have rejected more than $10 billion from the federal government that could have been used to expand Medicaid, even with the federal government offering to pay between 90% and 100% of the cost.

And the Mississippi legislature not only is opposed to the FREE MONEY!, it's also opposed to anything that looks remotely like FREE MONEY!
While neither chamber of the House has voted to pass any version of Medicaid expansion, the Senate under Hosemann has passed bills twice since 2021 that would have extended postpartum care for new mothers from 60 days to 12 months. Both times, however, Mississippi House Speaker Philip Gunn killed the legislation, falsely conflating it with Medicaid expansion earlier this year and telling the Associated Press that he wants to “look for ways to keep people off (Medicaid), not put them on.” Gunn is a past chairman and a current board member of the American Legislative Exchange Council, a conservative organization that provides template legislation to statehouses across the U.S.

The prion disease has many manifestations among its thousands of human hosts. Some of them are garish and public, like the one taking place on television in the House of Representatives; but most of them take place far from the spotlight. Small epidemics with big body counts.






CHARLES P. PIERCE


Charles P Pierce is the author of four books, most recently Idiot America, and has been a working journalist since 1976. He lives near Boston and has three children.

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