Voters should seize the opportunity to expand Medicaid

Medicaid is a vital program that enables millions of Americans to live healthy lives. It is also an important economic driver, particularly in states that have chosen to expand Medicaid under the Affordable Care Act.

Take Montana, one of the states in which the health care system I run operates hospitals and clinics. Before Medicaid expansion started in 2016, 15 percent of Montanans lacked health insurance. Today, after expansion, less than 8 percent of them don’t have health insurance. Moreover, the expansion has created 5,000 new jobs and generated nearly $300 million in new personal income for Montana residents. That is an unequivocal success we should all get behind.

On Tuesday, Montana voters will decide whether to approve a ballot initiative that would continue the state’s expanded Medicaid coverage or let it expire. The choice should be obvious, but recent polling shows a troubling trend: Voter support for expansion is waning even though Medicaid expansion provides essential coverage for more than 96,000 Montanans and brings clear economic gains to the state as a whole.

Utah, Idaho, and Nebraska also have Medicaid expansion questions on the ballot this year. I urge voters in these states to seize the opportunity to pass these initiatives to provide access to safe, affordable health care to residents who need it most.

For many Americans, the ability to access and afford care depends on Medicaid, which today covers 74 million people across the country. More than 60 percent of seniors living in nursing homes — our moms, dads, and grandparents — are covered by Medicaid. Nearly 1 in 10 veterans depend on Medicaid, as do nearly half of all children. Even for people who usually have employer-provided coverage, Medicaid provides an essential backstop when that coverage is unavailable or insufficient.

Virtually all Americans are vulnerable to unforeseen medical hardships that can impose unaffordable costs for themselves and their loved ones. Medicaid is a vital safety net for more people than we may realize, including our neighbors, friends, and family members.

Yet we have a fundamentally unequal system of Medicaid eligibility, because some states continue to resist expanding coverage, even though it means leavings millions of dollars in federal funding on the table.

Working for a not-for-profit health care system that serves seven Western states, my colleagues and I see the stark contrast between states that have expanded Medicaid coverage and those that have not.

California, Oregon, Washington, and New Mexico, which expanded Medicaid early on, have all seen significant declines in the number of working-age adults who are uninsured. In New Mexico, the adult uninsured rate declined from 28 percent in 2013 to 13 percent in 2016; in California it declined from 24 percent to 10 percent in the same period. This means more residents in those states are getting the care they need when they need it, leading to better health outcomes, increased productivity, and lives saved.

Our group also operates hospitals and clinics in Texas, one of 17 states that has not expanded Medicaid coverage under the Affordable Care Act, leaving their lowest-income residents without health insurance. In these states, the cost of not expanding Medicaid has been high. According to a recent report by the federal Government Accountability Office, low-income adults in non-expansion states are two times more likely to forego necessary medical care because they can’t afford it than those in states that expanded Medicaid. When people forego care because it is unaffordable, we all bear higher costs.

People in Texas and other non-expansion states are making their voices heard. They are telling their representatives they want to expand Medicaid to guarantee the same access to coverage they would be eligible for in other states.

There is an opportunity to extend coverage to millions of people who have been left out of equal access to care. Let’s seize that opportunity in the states where this important question is on the ballot this year, and advocate for other states to expand Medicaid coverage as soon as possible.

I can almost hear the critics scoffing as they read this, “Of course he supports Medicaid expansion. It will benefit his hospitals.” I am making this case as the CEO of a not-for-profit health care system that is committed to serving all patients who walk through our doors, regardless of their ability to pay or their insurance status. I would be making the same case if I was an independent academic health policy researcher, because Medicaid expansion is the right thing to do for millions of Americans.

Every single person in this country has the right to health. But that right is meaningful only if they have the support they need to live their healthiest lives.

Medicaid is an essential element of an equitable and just American health care system. When it is available unequally across our country, we fall short of our most basic obligations to one another. Health should not be determined by wealth, location, or access. We cannot let the opportunity pass us by to make an appreciable difference in millions of people’s lives.

Rod Hochman, M.D., is president and CEO of Providence St. Joseph Health.