The Politics of Self-Destruction: Racial Animus Continues to Fuel Medicaid Opposition.

Posted on | September 16, 2021 | 1 Comment

Mike Magee

If you like to see a political party self-destruct, you need only accompany the likes of Governors De Santis and Abbott, and failed California candidate Larry Elder who went down 2 to 1 in his states recall election this week. And If you would like to visit the meeting place of America’s two great contemporary pandemics –COVID-19 and structural racism – you need only walk down the historic Medicaid path and enter the dangling doors of its most vulnerable populations.

The current pandemic is disproportionately killing and maiming Black and Brown Americans. This should come as no surprise to Medical Historians familiar with our Medicaid program. Prejudice and bias were baked in well before the signing of Medicaid and Medicare on July 30, 1965.

President Kennedy’s efforting on behalf of health coverage expansion met stiff resistance from the American Medical Association and Southern states in 1960. Part of their strategic pushback was the endorsement of a state-run and voluntary offering for the poor and disadvantaged called Kerr-Mills. Predictably, Southern states feigned support, and enrollment was largely non-existent. Only 3.3% of participants nationwide came from the 10-state Deep South “Black Belt.”

Based on this experience, when President Johnson resurrected health care as a “martyr’s cause” after the Kennedy assassination, he carefully built into Medicaid “comprehensive care and services to substantially all individuals who meet the plan’s eligibility standards” by 1977. But by 1972, after seven years of skirmishes, the provision disappeared.

Medicaid has always disproportionately served as a backstop for Black Americans. They are more likely to be financially eligible, and more likely to spend their final years in Nursing Homes funded by Medicaid dollars. They are also likely to die younger than white counterparts, have twice the rate of heart disease, high blood pressure and stroke. For younger Black women, lack of access to maternity care and mental health services places them at high risk. Their children are 500% more likely to die of asthma than white children.

Southern states, led by Republican governors, have also led the way in a decade long battle to collapse the Affordable Care Act, and most notably the 90% federally funded expansion of Medicaid services and eligibility which the Supreme Court deemed voluntary in a landmark 2012 decision. Until 2017, eighteen states stubbornly held ranks. But in the past three years six states (Idaho, Utah, Oklahoma, Nebraska, Maine and Missouri) have fallen in line after voter propositions passed in their states.

That leaves some 2 million vulnerable citizens without coverage that is readily available. Polls in those states show that 2/3rds of their citizens favor Medicaid expansion in opposition to their own governors – and that was before the pandemic. Even in red counties of red states, 1/3 of Republicans are polling in favor of Medicaid expansion.

When COVID-19 hit, Nursing Homes were at the epicenter. Thanks to the action of Republican governors and their opposition to vaccines, children are now also in the cross-hairs. The major Southern states resisting enrollment in Kerr-Mills in 1965 were Texas, Arkansas, Louisiana, Tennessee, Mississippi, Alabama, Florida, Georgia, South Carolina, and North Carolina. Today, eight of the twelve states resisting Medicaid are the same, and their hospitals have been overwhelmed for a second time by Covid. These 12 states account for 92% of adults eligible for but not covered by expanded coverage. As such, they are last in line for COVID-19 testing, PPE, and vaccines.

As a recent Health Affairs article concluded: “Addressing these ills through policy is not the only step needed to end racism in our country, but it is a necessary—and long overdue—step.”

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Comments

One Response to “The Politics of Self-Destruction: Racial Animus Continues to Fuel Medicaid Opposition.”

HealthForce Training Center
September 20th, 2021 @ 4:59 pm

Greetings!

very interesting information.Thankyou for all your efforts that you have put in this blog.

HealthForce Training Center
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