As insurance exchanges open and millions of citizens explore their options under the Patient Protection and Affordable Care Act, known as Obamacare, millions more have fewer new options thanks to state governments that “opted-out” of a Medicaid expansion included in that law.
Cornell has three experts on government, race and politics, and ethics who are available to discuss the impact of, and inherent bias in, these opt-out decisions. They are:
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Jamila Michener, assistant professor of government, specializes in the field of American politics, with a particular focus on the political precursors to, and consequences of, poverty and racial inequality. She says:
“Given the geography of race and class in the U.S., poor people of color stand to suffer most from states’ refusal to extend health benefits to their most disadvantaged populations. The million-dollar question: are decisions about the Medicaid expansion motivated by racist intent? It is impossible to know. What we do know is that, regardless of politicians’ intentions, race pervades the politics surrounding Medicaid. “Opinion polls show that southern whites are substantially less likely to support the Medicaid expansion than African-Americans. Furthermore, the race- and class-based political inequalities that permeate the U.S. electoral system ensure that many of the politicians who are least inclined to support Medicaid will never be held accountable to the constituencies whose lives will be most acutely impacted by their decisions. “Notwithstanding anybody’s intentions, governors and legislators in places like Louisiana, Florida and Texas, cannot distance themselves from the racial realities underlying their decisions to deny health insurance to millions of our country’s least privileged citizens. They also cannot plead ignorance or innocence over the ever-growing problem of racial and ethnic health disparities.”
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Riche’ Richardson, associate professor in the Africana Studies and Research Center, is a scholar of African American literature and and southern studies. She says:
“Throughout much of the 20th century, many African Americans migrated to the urban North for industrial jobs, and in some instances, to escape the racial segregation, violence and repression that they experienced or witnessed in the U.S. South. As statistics have shown, this pattern began to taper off by 1970 and over the past several decades, the South has undergone a black population boom of sorts. If we consider that once again, the majority of the demography of blacks is concentrated in the region, and if we also factor in how profoundly many African Americans have been impacted by the economic downturn of the past few years, then we can see how this population would also be disproportionately impacted by the aspect of the health care policy that leaves it up to states to opt into or out of its provision for Medicaid expansion.
“I can understand why some feel that the pattern of opting out across Southern states recalls the ‘Southern strategy’ that was mainstreamed and nationalized within the neoconservative movement during the post-civil rights era, and that is often associated with reactionary policymaking agendas typically inimical to the interests of blacks and other minorities. Similar observations were made in 2009 about the concerted opposition among Southern states to the stimulus package.
“While the implementation of the new health care policy is an important milestone, more provisions should be in place to protect and provide for some of the nation’s most vulnerable citizens who are now left between a rock and a hard place because they are not in states willing to expand Medicaid.
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Richard W. Miller is the director of Cornell’s Program on Ethics and Public Life, and professor of philosophy. He says:
“The Republican governors and legislators who have rejected expansion of Medicaid through Obamacare in 26 states seem to have failed a major moral test.
“Whatever their views of economic inequality, foreign aid or fairness, decent people agree that the failure to help needy fellow citizens avoid disease and early death, or to do enough to help their children, is a morally serious matter.
“The desire to deprive Obama of credit for a positive change is not morally serious enough to justify this massive refusal to help. The governors and legislators appeal to alleged heavy costs, as the states' share rises from nothing now to 10 percent in 2020. But careful independent estimates of the expanded expenditure on Medicaid are much lower than theirs, often half or less. And the politicians take no account of large reductions in what states now pay for emergency room visits and other treatment of the poor uninsured.
“Flimflam about costs is not a morally serious response to suffering, either.”
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