Historically, the Mason-Dixon line divided states that embraced slavery and those that rejected it. Today, there is a new Mason-Dixon line in America. This time, it’s a dividing line for Medicaid, one of the country’s most important health insurance programs.
Thanks to the Affordable Care Act, all states can now expand Medicaid coverage to almost all their poor and near-poor residents. But almost half of our states are saying no. This expansion of Medicaid comes with almost full federal funding, which means that money is not driving these decisions.
The U.S. Supreme Court’s recent refusal to pull health care subsidies from 6.4 million Americans over some imprecise wording in the Affordable Care Act was a mercy. But health care remains a stark and shameful instance of the nation’s failure to overcome persistent racial disparities.
That owes in part to an earlier Supreme Court ruling. Originally, the Affordable Care Act’s Medicaid expansion was supposed to be implemented across the board, in every state. But the in 2012 the Supreme Court gave states the option of rejecting the expansion. This led to the shocking coverage gap we have today.
As of the beginning of this year, 3.8 million low-income adults lacked health insurance as a result of these rejections. These are people with incomes too high for their states’ regular Medicaid programs but too low to qualify for the Affordable Care Act’s subsidies for private coverage.
Those pushed beyond the health care margins are disproportionately people of color. The Kaiser Family Fund has calculated that 27 percent of the uninsured are African American and 24 percent are Latino. Most of these people live in states of the Old Confederacy.
By picking up the Medicaid expansion, Texas alone could deliver health insurance to more than three-quarters of a million people, including more than a half-million Latinos and 160,000 African Americans. But the state has chosen not to do so.
Behind the figures are real people whose lives depend on the health coverage that Medicaid provides. They need this insurance for heart medication, chemotherapy treatments, and the routine exams that can detect cardiovascular disease and cancer. These families face devastating financial consequences — more than half of all bankruptcies are due to medical bills.
The Affordable Care Act is now delivering coverage to 10 million Americans who were previously shut out of the health insurance system. And due to persistent racial disparities in coverage, most of those who remain uninsured live on the wrong side of the Medicaid Mason-Dixon line.
Texas and other states that are refusing Medicaid expansion are telling millions of residents of their states that their lives are not valued or worthy of protection. Now, more than ever, we need to show that we value all lives.
It’s not too late for state lawmakers to place themselves on the right side of the Medicaid Mason-Dixon line.
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Gail Collins will return.