Posted on | October 3, 2013 | 4 Comments
In Spring, 1974, my Chief Resident in Surgery at the University of North Carolina, walked into the Emergency Room. It had been a particularly grueling night filled with blood, anguish and the sound of helicopters landing and sirens blowing. The team had performed well, including me – an intern with less than a year’s experience. So the Chief, a huge and commanding figure, born and bred in North Carolina, stopped and looked me in the eye and said, “Magee, You’re alright. But you’ll always be a Yankee.”
That has proven to be true, I suppose, and yet my affection and respect for UNC, its leaders, as well as those throughout the South, have remained strong over a three decade period. It has been reinforced by relationships with key Southern leadership of the AMA and AAMC, AHA, AAFP and others; by visits to many Southern health systems, medical schools, nursing schools, colleges, universities and long term care facilities; and by visits to every state house in the South, and many corporations and institutions that call the South their home.
From these many points of contact, I’ve learned, as a “Yankee”, to be cautious not to jump to quick conclusions; and have always sought to understand the complex range of issues that challenge these states as they attempt to govern the various institutions and functions that impact human potential and success.
It’s fair to say that the launching of Obamacare, and the related threats to “shut down the government” have done little to promote unification of our “United” States, and less to offer solutions.
A case in point is this morning’s front page article in the New York Times titled, “Millions of Poor Are Left Uncovered By Health Care Law”.
The article addresses a very serious issue – Expansion of Medicaid as part of Affordable Care Act’s strategic plan to insure all Americans. Here are the facts:
1. The ACA as passed would have required that states expand Medicaid eligibility to all adults under 65 who made less than 133% of the Federal Poverty Level. This was to address the needs of the “working poor”, a population that is not poor enough (by some state definitions) to receive Medicaid coverage, but also not rich enough to afford health insurance.
2. In return for participation, states would be reimbursed 100% of the additional costs to the program through 2016, and no less than 90% thereafter.
3. The Supreme Court ruling in 2012 upheld the ACA but allowed states to choose whether they would expand state Medicaid programs.
4. 26 states have thus far declined to participate.(They have until January 1, 2014 to decide.) These include all of the Southern states except Arkansas – but also include New Hampshire, Pennsylvania, Ohio and Tennessee
5. Approximately 14 million Americans are uninsured and living in poverty. States opting out leave 8 million of these without an insurance option.
Those are the facts. The article moves from these facts to an historical perspective and racial ties, singling out Mississippi – and here’s where we enter the “land of the unhelpful”.
Dr. Aaron Shirley, a Misssissippi physician who has worked for better health care for blacks is quoted, “If you look at the history of Mississippi, politicians have used race to oppose minimum wage, Head Start, all these social programs. It’s a tactic that appeals to people who would rather suffer themselves than see a black person benefit.”
But Sara Moye and Clara Dancer (above) are part of Mississippi too. They found each and helped each other as part of a poverty program in Mississippi. They didn’t have to overcome racial barriers, but were challenged by class and income barriers.
The facts challenge Mississippi:
1. Mississippi has the largest percentage of poor and uninsured people in the country – 13%.
2. Mississippi’s ceiling for Medicaid eligibility is currently $3000 annually, and adults without dependents do not qualify. This is what their leaders believe they can afford to provide.
3. Were Mississippi to have accepted expansion through the ACA, estimates are that 1/3 of it’s population would have been on Medicaid. These numbers, the state reasoned, by 2016 when the state took over 10% of the financial impact, would have overwhelmed the state.
4. By rejecting the deal, Mississippi basically accepted the status-quo as their continuing reality, that is caring for their poor when they become desperately ill in emergency departments and state hospitals by state doctors. Most would agree, it’s a road to nowhere. But how do you break the poverty cycle?
The dilemma that Mississippi faces is a real one, quite independent of history, race and a variety of other factors. It is about demographics. Too many poor, too little revenue, too few resources, and too few ready solutions at hand.
But in Mississippi, as in other states throughout the South, people do care for each other, doctors and hospitals do try, but mistrust runs deep – and articles like this that jump too quickly into racial politics don’t help.
At least that’s what I was thinking as I read the Times over my morning coffee. So I decided to see what was coming in under “comments” on the online version of the article. Below are a few I have chosen:
Phytoist from N.J. Leads With A Strong Left Hook
Who are responsible for those millions left uncovered under new ACA Health Laws? The 26 Red States’ elected representatives in congress & senate & their selected Governers(mostly GOPers)& demographically most from southern part of our nation. Mostly poor in red states are left @ will of their Governers as they are blocking expansion of MEDICAID with a purpose to fail presidency because our president is not one of them & not a Republican… GOPTPERS are nothing but wolves under human skins with most cunning desires for power grab & thats why they are most loved by FOXy media mouths who make millions with their help.
rsinkowitz from NY Recognizes Demographic Realities – and The Need For National Solutions
National Health Care is a requisite to control costs and improve the quality of care. National means just that, states should not be made to pay a disproportionate amount of the bill for the mix of its populace~
Vict; Believes It’s Not About Mississippi, It’s About Capitalism.
“Incredible that you sneer at the working poor, that means people who work full time yet don’t earn enough to pay for medical insurance, good food, good housing, good living. As the rich eat the profits of their slave labor and refuse to pay living wages to those they exploit, the concerns of the working poor are to keep gas in the tank, buy a new pair of shoes for their kids. Your attitude is sickening. Warren Buffet says we pay for welfare because WE KNOW that capitalism is unfair. To blame those who suffer is the height of cruelty.”
Leeny2 from San Francisco asks “How Are The States To Pay For This?”
“In Mississippi, Republican leaders note that a large share of people in the state are on Medicaid already, and that, with an expansion, about a third of the state would have been insured through the program. Even supporters of the health law say that eventually covering 10 percent of that cost would have been onerous for a predominantly rural state with a modest tax base. To expand Medicaid in states with a large percentage of people living in poverty sounds good, but how are the states to pay for it? The uninsured (medically indigent) will flock to the ERs as they are have done for years. The hospitals will go broke seeing patients with no reimbursement.”
Mark NW from Seattle says, “It’s About Values.”
In the end, anything other than universal health-care coverage, is wrong.
In the end, prisons and wars for profit are wrong.
In the end, non-affordable education is wrong.
In the end, a country awash with guns is wrong.
In the end, laws that perpetuate bigotry, fear, and ignorance, are wrong.
In the end, until America changes its focus towards humanity and justice, we will be a country losing its soul. Arsenals and bombs cannot protect us from that fate. Fear – not hope – will be our guiding star.
Michael Cassady from Berkeley Relabels The “American Success Story”.
“If Horatio Alger was given the job of describing this American success story on how to turn a profit from misery, he might have given it the title, ‘Rags to rags.’ ”
spider41 from Oregon Suggests Jesus Would Find This Intolerable and Says “Don’t Forget, It Was the Supreme Court.”
“This is heart breaking. I have never hated Republicans before, but their reaction to the Affordable Care Act and now shutting down the government over it is enough to push me over the edge. I would like to be forgiving, but these people are so incredibly self-righteous and selfish, that I can’t imagine the Jesus most of them worship tolerating what they are doing. We can blame Republicans in Congress, Republicans in charge of state governments and Supreme Court Justices appointed by Republican presidents for this sorry mess. Don’t forget, it was the Supreme Court that allowed the states to opt out of the Medicaid provision.”
expat from Australia Seems Exasperated
“for pete’s sake! just get a nationalized single payer system already!!”
So don’t blame Mississippi. It’s not we vs. they. It’s us. That’s why we created the United States. And as t.gunn of nyc writes “Make it work.”
For Health Commentary, I’m Mike Magee.