The Gallup polling organization has come out with its latest list of the 10 most religious states as defined by church attendance. All but one — heavily Morman Utah — are in the South or Southwest. At the other end of the spectrum, the least religious states consisted of the entire New England region (except tiny Rhode Island) and the Pacific Northwest, plus Colorado, Hawaii and Alaska.
When one compares this list to the states that have or have not expanded Medicaid, the results are startling. Only one of the least religious states, Alaska, has failed to expand Medicaid (and it is strongly considering expansion). On the other hand, only two of the most religious states, Arkansas and Kentucky, have done so.
I am not a very religious person. However, it is hard for me to accept this dichotomy in that one of the basic tenants of the Judeo-Christian ethic is to help the sick and downtrodden.
When I talk to my more religious friends — almost all are very conservative — they have not given very convincing answers why this situation exists.
They say the South/Southwest is very conservative. Yes, it certainly is. But it is also the most religious. And that once again begs the question: If our Judeo-Christian tradition is one of caring, why hasn’t our region accepted the expansion of health care to those in need?
When further pressed, my friends say we have to be practical. Georgia simply cannot afford this expansion.
But the facts are very different. According to studies done by the Georgia Budget and Policy Institute, the cost is relatively reasonable — especially when we consider the federal government is legally committed to picking up 100 percent of the first three years of implementation, gradually decreasing to 90 percent afterwords. GBPI estimates the cost for the years 2014 to 2023 to be only $35 million a year due to offsetting tax revenues created via increased economic activity.
Along these lines, a 2014 study by Dr. William S. Custer, director of the Center for Health Services Research at the J. Mack Robinson College of Business at Georgia State University, found Medicaid expansion would create 70,000 new jobs, primarily in the private sector.
Kentucky, much smaller than Georgia, was one of two Southern states to buck the trend and implement Medicaid expansion, citing a similar cost-benefit report. In February, Kentucky came out with an updated analysis of its expansion. According to Gov. Steve Beshear, a study from Deloitte Consulting and the University of Louisville has shown expansion has already resulted in 14,000 new jobs, and the state expects to hit its target of 40,000 new jobs within seven years. The net economic impact is estimated to be $30 billion by 2021.
I am a former two-term Georgia county commissioner. As chairman, I led my county commission in reducing annual tax increases from 10 percent to 1 percent, well below the rate of inflation and one of the lowest rates of increase in the state. As former chairman of the tax committee of the Association County Commissioners, I understand the difficulty of raising taxes.
But if Georgia is turning down Medicaid expansion, it clearly is not doing so on sound economic grounds, especially when we consider the many millions in taxes our governor has forgone to attract new businesses to our state. Wouldn’t it make more sense to build our existing businesses and health providers via Medicaid expansion, creating the jobs we so desperately need?
This leads us back to the question as to why we don’t expand Medicaid in Georgia. Frankly, the only answer that makes any sense is raw politics ignoring both rationality and the decency expounded in our religious traditions.
Jack Bernard, the first director of health planning for the state of Georgia, has been a senior-level executive with several national health care firms.
