GOP at odds with public in South over Medicaid expansion

Five Southern states polled by Families USA rejected the ACA provision despite 62% of residents’ backing; some area physicians urge program reforms before expansion.

By — Posted June 7, 2013

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New polling suggests that Medicaid expansion enjoys solid public support in the South, although some physician organizations in this area of the country argue that their respective programs aren’t strong enough to sustain new enrollees.

Consumer advocacy group Families USA polled 500 constituents in Alabama, Georgia, Louisiana, Mississippi and South Carolina — states that so far have chosen not to expand their respective programs starting in 2014. The poll found that more than 62% favored the Affordable Care Act provision, with South Carolina residents showing the highest amount of support at 65% and Mississippi the lowest at 59% (link).

After breaking down the results into more specific demographics, researchers found that support for expansion was higher among African-American and liberal constituents in these states compared with non-Hispanic white residents and those with conservative views. Still, nearly 47% of those who identified themselves as conservative said they supported the Medicaid expansion. Among various age groups, younger respondents favored expansion slightly more than older ones.

Many Republican-led states have rejected the idea of expanding Medicaid up to an effective rate of 138% of the poverty level under the Affordable Care Act, despite the federal government’s commitment to cover all of the costs of caring for the newly eligible for the first three years. States eventually take on up to 10% of expansion costs. Washington consultant Avalere Health LLC has projected that 26 states won’t expand Medicaid in 2014.

Ron Pollack, Families USA’s executive director, said the polling results show that Southern governors resisting expansion are “out of step with the needs and wishes of their constituents.” He added that these governors need to acknowledge that Medicaid expansion “is a win-win-win for the people of their states. It will reduce the number of people who can’t afford health care, it will increase the number of jobs throughout the state, and it will strengthen the state’s economy.”

The poll was conducted on behalf of Families USA by the Joint Center for Political and Economic Studies, a Washington research and policy organization dedicated to issues of particular concern to African-Americans.

Some doctors want reforms first

Governors resisting expansion have said it would be too costly to states, resulting in tax increases and cuts to other fundamental services. Some medical organizations in the region have stated that their Medicaid programs already are broken and don’t have enough participating doctors to withstand a broad expansion.

In Georgia, Medicaid physicians “are paid at a rate that is less than the cost of delivering the services. This simply isn’t a sustainable business model for practices that have employees and other bills to pay,” said Donald J. Palmisano Jr., executive director of the Medical Assn. of Georgia.

In addition, the number of physicians accepting Medicaid patients has declined by more than 15% over the past four years, Palmisano said, citing statistics from the Georgia Dept. of Community Health. This has raised concerns that some of the most underserved patients, particularly those in rural areas, “will ultimately suffer, because it’s going to become increasingly difficult for them to find a physician.” For these reasons, it is critical for the state to fix the Medicaid program as it considers the prospect of expansion, he said.

The South Carolina Medical Assn. expressed similar views that expanding Medicaid alone would be unsustainable and not provide a solution for the long-term health issues facing the state. Tony Keck, director of the South Carolina Dept. of Health and Human Services, said the state has been trying to focus on improving health care outcomes “while lowering costs, intervening in hot spots of poor health, and freeing up wasted money in Medicaid for the Legislature to tackle the most important contributors to better health in South Carolina — jobs, education, and strengthening families and communities.”

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