Socialization of Scarcity and Medicaid Expansion in Mississippi.
Tuesday of this week I read an article that gave me hope. Lawmakers in Mississippi had struck a deal to expand Medicaid and provide health insurance coverage to an additional 200,000 low-income residents earning less than 138 percent of the federal poverty level (about $42,000 per year for a family of four). Not only would the expansion help secure higher quality healthcare for low-income families, it would also provide a financial boost to a struggling health care system and many small-town hospitals and economies in Mississippi. (Some of you may recall that I wrote a post in March about rural health care in which a failed hospital in Belzoni, Mississippi played a prominent role.)
Mississippi is one of only ten states that have not expanded Medicaid under the Affordable Care Act. Expansion in Mississippi has widespread public support within the state. Seventy-two percent of voters support expansion and 92 percent are concerned about the state’s hospital crisis. Further, the federal government would pick up 90 percent of the tab for the expansion making the new law a financial net benefit for the state (once other financial benefits to the wider economy are considered). It appeared that everyone in Mississippi would come out a winner.
The good news took a tragic turn yesterday. Mississippi Governor Tate Reeves considers Medicaid expansion “welfare.” While running for re-election last October he stated, “Adding 300,000 able-bodied adults to the welfare rolls is not the right thing to do.” In an effort to appease the Governor and other conservative Republicans like him, the Mississippi plan required new enrollees to be employed in the labor market for at least 25 hours per week. Yet, that wasn’t enough for Reeves. In order to avoid a Gubernatorial veto the bill needed a 2/3 majority. It fell short and now must wait until Mississippi’s next legislative session to be re-considered.
When I reflect on this debate and the outcome in Mississippi, I’m struck by the callousness of some of our Republican legislative leaders and their supporters across the country. Consider a family of four at the top rung of the 138 percent mark of the poverty level. This family is making $42,000 per year. The average premium for a non-subsidized health insurance plan for this family is $1,437 per month or $17,244 per year. The typical non-subsidized health plan for this family would consume over 40 percent of their pre-tax income. Most people would have their mortgage application rejected by a bank if their mortgage payment made up this share of their income. For a family at the poverty level, this average health insurance plan would consume 55 percent of pre-tax income. Yet, the Governor of Mississippi expects low-income families to manage this cost or forego health insurance. He calls health insurance subsidies for families in this position “welfare.” Implicitly he describes these families as not worthy of health care.
When I reflect on his comments I’m remined of a quote from well-known physician and activist, Paul Farmer, from a 2018 interview:
“…the people who make grand pronouncements about what is or isn’t cost-effective, feasible, sustainable, reasonable — it’s not that they think that some people are worth less than others. And they’d be horrified to be called racist or sexist. So what is it, if it’s not really that? I think it’s more often socialization for scarcity on behalf of other people. This is something I’ve been struggling with since I was a student: socialization for scarcity. But scarcity for ourselves? No. Scarcity for our mom? No. For our own kids? No. We’re socialized for scarcity for other people, and they’re usually black or brown or poor. So then we start cutting corners.”
I wonder how Governor Reeves would feel if his mother worked as a bank teller or seamstress and couldn’t afford health insurance? Would he still want to cut corners on Medicaid expansion? Or what if it was his child who worked on a farm from dawn to dusk? Or as a restaurant server or cook? A day laborer at a construction site? A health care aide in a retirement home? Would scarcity of health care be ok for his child if they worked in one of these professions? Can we imagine our society functioning without these workers? Are they not deserving of the comfort of knowing that they won’t be bankrupted by an unfortunate accident or illness? Is it ok to accept scarcity for them? Its appalling that we continue to accept this scarcity of healthcare for those who work difficult and meaningful jobs.
Yet, we do this and we allow it in election after election.
Troy Tassier is a professor of economics at Fordham University and the author of The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us during Outbreaks.