Wednesday, August 27, 2014

There’s another scandal in American health care

Photo by Spencer Platt/Getty Images

The investigation is ongoing, but as of now, it looks like overwhelmed VA hospitals shunted some veterans onto secret wait lists and delayed their care (read Vox's explainer here). The revelations are correctly being treated by both parties as a national scandal: denying Americans health care to which they're legally entitled doesn't simply inconvenience them. It can kill them.

We don't know how many veterans were hurt by the VA's secret wait lists. The VA was aiming for waits of no more than 14 days for non-urgent appointments, but Timothy Noah cites "an internal VA estimate" based on more reliable data that puts the average wait closer to 21 days. The investigation is likely to find hospitals where the average wait was much longer, and individual cases where the waits were truly appalling — and perhaps fatal.

It's a relief to see so much outrage over poor access to government-provided health-care benefits. But it would be nice to see bipartisan outrage extend to another unfolding health-care scandal in this country: the 4.8 million people living under the poverty line who are eligible for Medicaid but won't get it because their state has refused Obamacare's Medicaid expansion.

As appalling as the wait times are for VA care, the people living in states that refused the Medicaid expansion aren't just waiting too long for care. They're not getting it at all. They're going completely uninsured when federal law grants them comprehensive coverage. Many of these people will get sick and find they can't afford treatment and some of them will die. Many of the victims here, by the way, are also veterans. So here are 24 health-care scandals that critics of the VA should also be furious about:

Alabama: Obamacare's Medicaid expansion would provide 272,000 poor Alabamans with comprehensive health insurance, including 13,000 veterans. But the state has refused to let the expansion go forward.

Alaska: Obamacare's Medicaid expansion would provide 30,000 poor Alaskans with comprehensive health insurance, including 2,400 veterans. But the state has refused to let the expansion go forward.

Florida: Obamacare's Medicaid expansion would provide 1,212,000 poor Floridians with comprehensive health insurance, including 41,200 veterans. But the state has refused to let the expansion go forward.

Georgia: Obamacare's Medicaid expansion would provide 599,000 poor Georgians with comprehensive health insurance, including 24,900 veterans. But the state has refused to let the expansion go forward.

Idaho: Obamacare's Medicaid expansion would provide 86,000 poor Idahoans with comprehensive health insurance, including 3,800 veterans. But the state has refused to let the expansion go forward.

Indiana: Obamacare's Medicaid expansion would provide 291,000 poor Indianians with comprehensive health insurance, including 13,700 veterans. Thus far, the state hasn't moved forward, but they're entering into negotiations with the Obama administration to do so soon.

Kansas: Obamacare's Medicaid expansion would provide 126,000 poor Kansans with comprehensive health insurance, including 35,700 veterans. But the state has refused to let the expansion go forward.

Louisiana: Obamacare's Medicaid expansion would provide 363,000 poor Louisianans with comprehensive health insurance, including 9,900 veterans. But the state has refused to let the expansion go forward.

Maine: Obamacare's Medicaid expansion would provide 38,000 poor Mainers with comprehensive health insurance, including 2,700 veterans. But the state has refused to let the expansion go forward.

Mississippi: Obamacare's Medicaid expansion would provide 203,000 poor Mississippians with comprehensive health insurance, including 7,100 veterans. But the state has refused to let the expansion go forward.

Missouri: Obamacare's Medicaid expansion would provide 283,000 poor Missourians with comprehensive health insurance, including 12,800 veterans. But the state has refused to let the expansion go forward.

Montana: Obamacare's Medicaid expansion would provide 63,000 poor Montanans with comprehensive health insurance, including 4,000 veterans. But the state has refused to let the expansion go forward.

Nebraska: Obamacare's Medicaid expansion would provide 56,000 poor Nebraskans with comprehensive health insurance, including 2,100 veterans. But the state has refused to let the expansion go forward.

North Carolina: Obamacare's Medicaid expansion would provide 511,000 poor North Carolinans with comprehensive health insurance, including 23,300 veterans. But the state has refused to let the expansion go forward.

Oklahoma: Obamacare's Medicaid expansion would provide 201,000 poor Oklahomans with comprehensive health insurance, including 10,000 veterans. But the state has refused to let the expansion go forward.

Pennsylvania: Obamacare's Medicaid expansion would provide 454,000 poor Pennsylvanians with comprehensive health insurance, including 19,100 veterans. Thus far, the state hasn't moved forward, but they're entering into negotiations with the Obama administration to do so soon.

South Carolina: Obamacare's Medicaid expansion would provide 289,000 poor South Carolinians with comprehensive health insurance, including 13,000 veterans. But the state has refused to let the expansion go forward.

South Dakota: Obamacare's Medicaid expansion would provide 40,000 poor South Dakotans with comprehensive health insurance, including 1,600 veterans. But the state has refused to let the expansion go forward.

Tennessee: Obamacare's Medicaid expansion would provide 266,000 poor Tennesseans with comprehensive health insurance, including 15,800 veterans. But the state has refused to let the expansion go forward.

Texas: Obamacare's Medicaid expansion would provide 1,727,000 poor Texans with comprehensive health insurance, including 48,900 veterans. But the state has refused to let the expansion go forward.

Utah: Obamacare's Medicaid expansion would provide 93,000 poor Utahns with comprehensive health insurance, including 3,800 veterans. But the state has refused to let the expansion go forward.

Virginia: Obamacare's Medicaid expansion would provide 313,000 poor Virginians with comprehensive health insurance, including 12,300 veterans. But the state has refused to let the expansion go forward.

WisconsinObamacare's Medicaid expansion would provide 53,000 poor Wisconsinites with comprehensive health insurance, including 6,400 veterans. But the state has refused to let the expansion go forward.

WyomingObamacare's Medicaid expansion would provide 27,000 poor Wyomingites with comprehensive health insurance, including 1,200 veterans. But the state has refused to let the expansion go forward.

8585-figure-2

All in all, the Kaiser Family Foundation estimates that more than 7.5 million uninsured adults would be eligible for Medicaid but live in a state that has refused the expansion. Of that group, 4.8 million are too poor to be eligible for subsidies in Obamacare's insurance exchanges. So they're out of luck.

This is a problem that affects veterans, too: The Pew's Stateline estimates that around 250,000 uninsured veterans would be eligible for Medicaid if their states accepted the expansion.

The point here isn't to minimize the problems at the VA, which need to be fixed — and fast. But anyone who feels morally outraged over the extended wait times at the VA should be appalled by the literally endless wait times the poor are enduring in the states that are refusing to expand Medicaid.

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