The miserable have no other medicine but only hope.
—Shakespeare, Measure for Measure
It is becoming increasingly apparent that it’s important for the poor to stay healthy. There is no way the seventh richest country in the world is going to be able to care for the poor if they get sick and they owe it to the rest of us to stay healthy. If they don’t, it inflicts on the more fortunate a sense of guilt, except of course, among those who attribute the state in which the poor find themselves, to their own lack of initiative. Those are people like Rick Perry, the governor of Texas.
In Texas one out of four people or 25% of its population has no health insurance, the highest number of uninsured in any state in the union. If the governor opted to accept all the benefits available to Texas under the Affordable Health Care Act (ACA), an additional 1.7 million Texans would find themselves insured through no effort on their part. That is an undesirable result since bestowing benefit without requiring effort encourages the indolent to remain indigent. That helps explain why Governor Perry is declining to expand Medicaid in his state. As he explained on Fox News, “The bottom line here is that Medicaid is a failed program.” To expand this program is not unlike adding a thousand people to the Titanic” (although in the case of Texas it’s 1.7 million people.) He refuses to expand the program even though a report from Harvard and another from the Congressional Budget Office state that health insurance is a good thing for people to have and expanding Medicaid programs enables more people to enjoy the benefits it provides.
A study in the New England Journal of Medicine compared mortality rates of the poor in seven states, three of which expanded their Medicaid programs beginning in 2000 and four of which did not. The states that expanded coverage were Maine, New York and Arizona and the states that did not expand coverage were New Hampshire, Pennsylvania, New Mexico and Nevada.
What Mr. Perry and others like him want, is for there to be fewer indigent people in their states. If this cannot be accomplished by getting the poor to develop incentive and find work, it can be accomplished by increasing the mortality rate among the poor by not expanding access to health care, thus producing the same result helping them find employment would produce.
The study found that “Medicaid expansions were associated with a significant reduction in adjusted all-cause mortality (by 19. 6 deaths per 100,000 adults, for a relative reduction of 6.1%). . . .” The report states that: “Mortality reductions were greatest among adults between the ages of 35 and 64 years, minorities, and residents of poor counties.” The report says that: “These findings may influence states’ decisions with respect to Medicaid expansion under the ACA.” The conclusion is correct although not necessarily producing the results the authors may have anticipated. Given the fact that there is a decreased risk of mortality among those who have health insurance Mr. Perry will undoubtedly be reinforced in his belief that Medicaid should not be expanded in Texas. What Mr. Perry and others like him want, is for there to be fewer indigent people in their states. If this cannot be accomplished by getting the poor to develop incentive and find work, it can be accomplished by increasing the mortality rate among the poor by not expanding access to health care, thus producing the same result helping them find employment would produce.
The Harvard report also cites the good results observed in the Medicaid expansion lottery that took place in Oregon beginning in 2008 that was discussed here some weeks ago. That study found that people with health insurance enjoyed better health than those without insurance, were less likely to be burdened by unpaid medical bills and more likely to make regular visits to a family doctor. Overall they enjoyed better health than those without insurance.
The Congressional Budget Office should also give Mr. Perry comfort. It has released the results of its study on the affect of the Supreme Court ruling on the number of people who will still be uninsured when the new law has taken effect. It was originally thought that if the expansion of Medicaid were compulsory 33 million people now lacking insurance would obtain insurance with its accompanying benefits by 2022 when the law took full effect. Since states were given the option by the Supreme Court of refusing to expand Medicaid coverage to cover low income childless adults, the CBO now believes that 6 million people will not be added to the Medicaid roles although 3 million of those will probably get insurance elsewhere thus leading to 3 million more U.S. citizens being without health insurance than the CBO had calculated when ACA first became law. Applying the results of the Harvard study to those 3 million, one can conclude that there will be increased mortality rate among this group thus demonstrating that there is more than one way to reduce the number of poor who are living among us. That, if nothing else, should give those who oppose ACA something to cheer about. Who’d have thought it?