Southern politicians have a long history of opposing efforts to provide government-funded health care to their constituents.
In 1947, President Harry Truman proposed legislation that would have essentially provided universal health care paid for through fees and taxes. Remember, health care options for working people were even more dire in those days than they are now, when fewer people had employer-sponsored health insurance.
Truman’s proposal was partially rejected by southern Democrats in the US House and Senate. Nobel Prize-winning economist Paul Krugman wrote in his book “The Conscience of a Liberal” that Southern politicians opposed the Democratic president’s plan because they feared it would lead to a government mandate to integrate hospitals.
“For Southern politicians, it was more important to keep black people out of white hospitals than to provide poor whites with medical supplies,” Krugman wrote.
Southern politicians, it turns out, still aren’t crazy about government-sponsored health insurance.
A quick look at the map of states that have and have not expanded Medicaid is impressive. Of the 11 states that did not expand Medicaid, eight (if you include Texas) are southern states.
In fact, the map of non-expansion states is very similar to the footprint of the Southeastern Conference Collegiate Athletic League, with the exception of Louisiana, Arkansas, Kentucky and Missouri. These four states expanded Medicaid. Sure, most would say Missouri isn’t a southern state, but it’s in the SEC.
Anyway, it’s the SEC states, led by southern politicians, now Republican southern politicians, who are once again resisting attempts to expand government-sponsored health care to help their poor constituents.
Of course, hospitals are no longer isolated. According to Krugman, they were brought together in the 1960s when another government-funded program was introduced: Medicare, which provides health care for the elderly.
Although various studies have found that the largest percentage of people who will benefit from Medicaid expansion are people of color, it is important to note that there are many white citizens who will also benefit.
Medicaid expansion, as authorized by the Patient Protection and Affordable Care Act, provides health insurance primarily to the working poor — people who earn up to 138% of the federal poverty level, or $18,754 per year per person. In Mississippi, the traditional Medicaid program covers, in general, poor pregnant women, poor children, certain groups of poor retirees and the disabled, but not the working poor.
The federal government pays the bulk of health care costs for those who have expanded Medicaid. When Southern politicians voice their opposition to Medicaid expansion, they often simply say they’re “against Obamacare,” as if that’s reason enough to oppose it.
“I am against expanding Obamacare in Mississippi. I oppose Obamacare expansion in Mississippi. I oppose Obamacare expansion in Mississippi. I don’t know how many ways I can explain it to you,” Republican Gov. Tate Reeves said in response to questions from reporters.
When in 2010, the country’s only black president, Barack Obama, passed the Affordable Care Act through Congress, almost all Republicans were against Obamacare. But now solidly Republican states like Montana, North Dakota, Utah and Idaho have passed Medicaid expansion. In Republican-controlled South Dakota, voters just approved an initiative to expand Medicaid. For the most part, it’s just southern politicians avoiding Medicaid expansion.
John Bell Williams also opposed health care expansion when he served in the US House of Representatives representing Mississippi. As a congressman, he voted against Democratic President Lyndon Johnson’s plan to enact Medicaid for a small group of the disadvantaged.
But as governor, Williams later called a special session in 1969 and urged the Legislature to take on the Medicaid program.
In his speech to the Legislature, Williams said, “Let’s not delude ourselves into the false notion that we can — or will — shirk the burden of caring for these unfortunate people. Our society, through the instrument of state management, has always assumed this responsibility, and I am sure that it will continue to be so.”
Williams went on to say that the state cannot afford to abandon the federal health care program, which only requires the state to match 20% of the funds. He talked about the economic impact it would have on the state.
“The simple fact is that someone pays for health care, and we have to decide who will do it and how,” he explained.
The special session lasted from July 22 to October 11. Eventually, the Mississippi Legislature passed the program, proving that Southern politicians were not always opposed to improving health care for their poor constituents.
Whether that will happen with Medicaid expansion remains to be seen.
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