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When politics intervene, public health policy decisions can get trampled. This is the case currently in Texas, Louisiana and South Carolina – three states whose governors have stars in their eyes, gazing toward future elections, with two of them hoping to be anointed Mitt Romney’s vice presidential candidate.
And while those running the show at Romney’s headquarters will surely deny that there is a litmus test any Veep candidate must pass, all three of the governors – Rick Perry (Texas), Bobby Jindal (Louisiana) and Nikki Haley (South Carolina) – aren’t taking any chances when it comes to “ObamaCare”.
Given leeway to not be penalized for failing to expand Medicaid in their states, the Governors have repeatedly and pointedly said they will not expand Medicaid. Further, they also won’t work to open a state health insurance exchange and will instead – in a twist of irony – use the federal fallback option instead.
[Political Malpractice: Are politics extinguishing state insurance exchanges?]
This despite the fact the expansion will be funded at 100 percent by the federal government through 2016 and at no less than 90 percent in ensuing years.
If any states could use money to help fund its healthcare program for the poor, it is these three, which have some of the highest rates of residents without health insurance in the country. In South Carolina one-in-six residents don’t have health insurance, totaling nearly 800,000 people. Louisiana has about 900,000 uninsured residents or nearly 20 percent of its population. And in Texas the statistics are staggering: 6.2 million uninsured, comprising approximately one-quarter of the population.
Yet, not one of these governors will step up to the plate and take the money allotted in federal health reform to expand Medicaid.
Jindal and Haley reportedly have their eyes on a potential slot as Romney’s running mate. Perry, whose presidential aspirations for 2012 flamed out, is eying his re-election for a potential fourth term as governor of Texas and could even be considering another bid at the presidency, should President Obama win re-election.
In other words, in the current landscape of the Republican Party, the only chance Perry, Jindal or Haley have of advancing their careers within their own party at least, is to earn their stripes through completely denouncing the Affordable Care Act.
But that comes at a steep price to the states’ coffers and the hospitals serving the poor. In Texas, not expanding Medicaid will deprive the state’s healthcare providers of more than $70 billion over six years. In Louisiana, Jindal has been actively slashing the state’s Medicaid budget to the bone; even before announcing the state wouldn’t look to expand using federal dollars. A recent round of more than half-a-billion dollars in cuts resulted in $353 million affecting one provider: the public health system run by Louisiana State University. In South Carolina, where hospitals and other healthcare providers serve as much as $1 billion in care to patients unable to pay their bills, that state may soon prove to have significant problems with access to care due to continuing cuts to Medicaid reimbursement rates.
Critics contend there is no place for politics when it comes to the health of the poor and uninsured – least of all in governors turning their backs on billion of dollars of federal healthcare funds. One editorial in South Carolina’s HeraldOnline said that in a state that pays only $1 and the federal government pays $9 for every $10 spent on healthcare, refusing the money that comes with Medicaid expansion “amounts to fiscal malpractice.”
According to Texas State Senator Leticia Van De Putte the people in her state are fed up with “political grandstanding and saber-rattling, just so politicians can position themselves as ‘Washington outsiders.’ And we're fed up with the damage that comes in the wake of these political moves – actions that will force millions to continue without insurance and put taxpayers on the hook for their medical bills, while throwing away billions of tax dollars that rightfully ought to come to Texas,” she wrote in a recent editorial.
The Texas Hospital Association – while agreeing that the current Medicaid system in Texas is flawed and probably couldn’t handle the influx of new patients inherent with expansion – was blunt about the status of healthcare affairs in the state. “Without the Medicaid expansion, many will remain uninsured, seeking care in emergency rooms, shifting costs to the privately insured, and increasing uncompensated care to healthcare providers,” read a statement from Dan Stultz, MD, president and CEO, of THA. “With a strained state budget, it’s hard to imagine addressing the uninsured problem in Texas without leveraging federal funds.”
The Louisiana Hospital Association is likewise faced with a grim situation after the recent round of cuts, which John Matessino, president and CEO of LHA said “dealt a huge blow to health services in our state.”
“The DSH cuts to rural hospitals will be critical and will lead to reductions in services and possible hospital closures,” Matessino said in a statement in reaction to the cuts. “This could leave gaps in healthcare delivery for patients in rural areas, as well as economic losses to those communities.”
The head of the Louisiana Democratic Party, state senator Karen Peterson, was blunt in her assessment of what can happen when politics gets in the way of policy. As she told the Associated Press in July: “It’s selfish as (Jindal) goes around the country touting his resistance to federal laws to bolster his own vice presidential predictions while the Louisiana healthcare system crumbles.”
Indeed, while Perry, Jindal and Haley use their Medicaid programs as political wedges, many of the poor, uninsured residents of Texas and Louisiana are left holding the bag and their hopes of gaining access to healthcare only gets farther and farther away.
For more of our politics coverage, visit Political Malpractice: Healthcare in the 2012 Election