The Affordable Care Act, as originally passed, holds
tremendous promise to decrease health care costs and increase insurance
coverage rates across rural states like Maine. But federal court
opinions and repeated vetoes of Medicaid expansion are putting all that
into jeopardy. Already, data is pointing to widening disparities between
the states embracing health reform and those that have resisted — in
the numbers of uninsured, in new health care jobs and in the finances of local hospitals.
Historically, the United States has maintained the highest health spending in the world, but it still had lower life expectancies and the highest rates of infant mortality
in the developed world. Health costs have sucked up 18 percent of our
gross domestic product, leaching out wage gains and damaging America’s
global competitiveness.
These factors drove Congress and the president to enact
health care reform. Since then, despite the fact that health care
utilization typically increases as the economy recovers from recession,
health care cost growth has been held in check and health economists
increasingly agree that this is due to the structural reforms initiated by the ACA.
And, with federal subsidies and Medicaid expansion to help cover the working poor, the number of people who are uninsured
in the country is going down. These are promising trends, but die-hard
reform opponents continue to work to reverse them. Every recalcitrant
governor, every contentious court decision impedes health reform from
realizing its full potential, despite its proven success to date.
There are two Americas. One is prosperous, long-lived and
healthy. The second comprises the working poor who are short-lived,
disabled early and beset by chronic illnesses that could have been
prevented — diabetes, heart failure, pulmonary disease. Those in this
second America are people who have a job — maybe two — but do not earn
enough to make ends meet.
We make special provisions for some of the most vulnerable
in this group — children, the elderly and disabled — but millions of
hard-working Americans fall through the gaps. And unfortunately, the
ranks of America’s working poor are increasing, not shrinking.
An American born in one of our rural counties is likely to live a shorter life
than a person in Algeria or Bangladesh. Meanwhile, Americans who live
in prosperous urban regions have life expectancies that rival the
healthiest places in the world. This disparity exists, and it takes
money. It costs our economy, through lost worker productivity and the
high price of treating people in emergency rooms when they cannot afford
less expensive preventive care.
As designed, health reform aimed to erase health
disparities. It pumped money into making affordable health care
available to Americans in poorer, more rural states like Maine. It
offered good jobs and billions in economic impact
while improving the quality of care to all Americans wherever they
live, whatever their income. It directed money to cost-effective primary
care and dedicated scholarship funds to increase the number of doctors in rural and underserved areas, like much of Maine.
The New York Times
recently reported that state-level refusal to expand Medicaid combined
with the recent court ruling jeopardizing subsidies to residents of
states on the federal exchange threaten to undo the national reform and
create a state-by-state patchwork. This would effectively maintain the
two Americas. The states that declined to expand Medicaid or design
state exchanges are mostly the poorer, less healthy states. Right now,
Maine is on this list.
Gov. Paul LePage has vetoed majority votes to expand Medicaid five times. If we continue in this direction, 12 percent of Mainers will continue to be uninsured while 96 percent of residents in nearby Massachusetts are insured.
Politics threaten to block health reform from fulfilling its
promise: to bridge the yawning gap in health and economic potential
between the two Americas. Partisan politics shouldn’t block Maine from
reaping the benefits of health reform — both in better health outcomes
and in expanded economic opportunity.
Christy Daggett is a policy analyst at the Maine Center for Economic Policy.
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