The long history of white southern politicians rejecting health care expansion

Southern politicians have a long history of opposing efforts to provide government-sponsored health care for their constituents.

In 1947, President Harry Truman proposed legislation that would essentially provide universal health care paid for through fees and taxes. Remember that health care options for working people in those days were even more dire than they are now, as fewer people had employer-based health insurance.

Truman’s proposal was rejected in part 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.

“Keeping black people out of white hospitals was more important to Southern politicians than providing poor whites with the means to receive medical treatment,” Krugman wrote.

Southern politicians, it turns out, still aren’t crazy about government-sponsored health insurance.

A quick look at a map of states that have and have not expanded Medicaid is startling. Of the 11 states that have not expanded Medicaid, eight (if Texas is included) are Southern states.

The map of non-expansion states actually looks a lot like the Southeastern Conference collegiate sports league footprint 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 is in the SEC.

In any case, SEC states led by Southern politicians, now Republican Southern politicians, are once again resisting efforts to expand government-sponsored health care to help their poor constituents.

Hospitals, of course, are no longer segregated. They were integrated in the 1960s, according to Krugman, when another government-sponsored program was introduced: Medicare, which provides health care for the elderly.

Although various studies have found that the largest percentage of people who would benefit from Medicaid expansion are people of color, it is important to note that there are many white citizens who would also benefit.

Medicaid expansion, as authorized as part of the Patient Protection and Affordable Care Act, provides health insurance primarily to the working poor — people who earn up to 138 percent of the federal poverty level, or $18,754 a year for an individual. In Mississippi, the traditional Medicaid program covers, broadly speaking, poor pregnant women, poor children, certain groups of poor retirees and the disabled, but not the working poor.

The federal government pays most of the health care costs for those on Medicaid expansion. When Southern politicians express their opposition to Medicaid expansion, they often simply declare that they are “against Obamacare,” as if that were reason enough to oppose it.

“I am against expanding Obamacare in Mississippi. I am against expanding Obamacare in Mississippi. I am against expanding Obamacare in Mississippi. I don’t know how many ways I can explain this to you,” Republican Gov. Tate Reeves said in response to questions from reporters.

When the nation’s only black president, Barack Obama, pushed the Affordable Care Act through Congress in 2010, almost all Republicans opposed 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 a ballot initiative to pass Medicaid expansion. For the most part, it’s only Southern politicians who avoid Medicaid expansion.

John Bell Williams also opposed health care expansion when he served in the Mississippi House of Representatives. As a congressman, he voted against Democratic President Lyndon Johnson’s plan to introduce a Medicaid program for a small portion of the disadvantaged population.

But as governor, Williams later called a special session in 1969 and urged the Legislature to get involved in the Medicaid program.

In a speech to the Legislature, Williams said, “Let us not delude ourselves into the false notion that we can — or will — avoid the burden of caring for these unfortunate people. Our society, through the instrument of government, has always assumed this responsibility and I am sure it will always do so.”

Williams said the state can’t afford to reject a federal health care program that would require the state to provide only 20 percent of the matching funds. He talked about the economic impact it would have on the state.

“The simple fact is that someone is paying for health services, and we have to decide who is going to do it and how,” he explained.

The special session ran from July 22 to October 11. Ultimately, the Mississippi Legislature got on board, proving that Southern politicians aren’t 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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