The Supreme Court may have ruled that the Affordable Care Act is constitutional, but part of their ruling may be causing some real conflicts for some states. The SCOTUS said that the states can decide on whether to expand Medicaid according to the ACA’s provisions. This left Republican governors an escape hatch of a sort and many of them are using it.

The ACA mandates that Medicaid be widened to include those with a household income of up to 138% of the federal poverty level ($15,420 to $31,812). They will cover the costs of all new patients from 2014 through 2016, requiring the states to pay only 10% after that. Current Medicaid patients would continue under the plan we use now, which is a sliding scale with Washington paying an average of 57 cents on the dollar. That’s an average: most Southern states are paid at a higher rate, anything between 68 (Alabama) and 74 cents (Mississippi), depending on the state’s per capita income.

The governors who are resisting the Medicaid expansion are all Republicans, all governors of Southern states. These are the very places that need Medicaid most of all. Southern states, most of which are red, are the poorest states in the U.S. These are also the unhealthiest states, with higher rates of diabetes, obesity, and smoking. These high rates translate to bad health and expensive medical care. The citizens of the South would benefit greatly from the Medicaid provisions of the ACA, yet their governors stubbornly cling to ideology and brush aside the actual welfare of their states.

From Virginia to Texas, Republican governors are digging in their heels on this issue. Either they don’t realize or don’t care that their constituents would be the beneficiaries of better, more affordable health care. Louisiana governor Bobby Jindal, who is chairman of the Republican Governors Association, is urging his Southern colleagues to use another component of the ACA, the insurance exchanges. That’s all well and good for much of their population, but many people fall into the crack between Medicaid and exchanges, making too much to receive Medicaid but not enough to get subsidies to buy into the exchange.





So why are these governors being so intransigent? Politics. Several of them are up for re-election soon and, as South Carolina State Rep. Kris Crawford admitted, “It is good politics to oppose the black guy in the White House right now, especially for the Republican Party.” It all boils down to that: oppose Barack Obama in every way, even if it kills their citizens.

A few representatives of hospital, physician and health care companies are trying to change minds. Drew Altman, president of the Kaiser Family Foundation, points out:

“Many of the citizens who would benefit the most from this live in the reddest of states with the most intense opposition.” (source)

Tennessee Hospital Association president Craig Becker has been taking a presentation around the state, speaking to civic and business groups. He has noted that:

“It’s really hard for some of them to separate something that has the name `Obamacare’ on it from what’s going to be best for the state,” going on to explain that personality driven politics are easier to understand than the complicated way that the U.S. pays for health care. “These are rock-ribbed Republicans. But they all scratch their heads and say, `Well, if that’s the case, then of course we do this.'” (source)

It is hard to justify depriving people of health care on the basis of ideology. But the Southern governors are giving it their all. Some of them are doing it in the face of studies by their own state agencies’ analysis of costs (hey, Bobby Jindal!). Georgia governor Nathan Deal is skeptical of his state’s hospital association projections of savings and of the fed’s promise to pay what they say they will.

As it stands, the Supreme Court has managed to create a scenario in which hospitals will lose revenue by caring for uninsured patients while not receiving compensation from the federal program. This could be ruinous for some. But the representatives of those hospitals and doctors are optimistic. These governors, despite their rhetoric, are looking for ways to accept all the ACA provisions while still being able to oppose “Obamacare,” they say. Perhaps they are correct. But with governors like Nikki Haley of South Carolina saying things like, “We will not expand Medicaid ever,” I’m skeptical. As we’ve seen time and time again since Obama took office, their ideology very often trumps doing the right thing.

T. Steelman is a life-long Liberal. She has been writing online about politics since 2007. She lives in Western Washington with her husband, daughter, 2 cats and a small herd of alpacas. How can anybody be enlightened? Truth is, after all, so poorly lit…