When it comes to resisting the implementation of the Affordable Care Act, no one's fought more aggressively than Texas Gov. Rick Perry (R) and South Carolina Gov. Nikki Haley (R) to deny benefits to their constituents. It's likely to cost their respective states dearly, but for both governors, a far-right ideological agenda trumps all other considerations.
Many have assumed that they'll fold in time, especially when it comes to Medicaid expansion, not because of public demand or pressure from struggling families in need of care, but because their in-state health infrastructure will simply not tolerate leaving so many resources on the table. We're already seeing some of this pushback.
As Jay Hancock reports today at Kaiser Health News, two groups of powerful interests are preparing to pressure Perry if, come next year, the state really does decide to opt out of the Medicaid expansion. One group is the hospitals that, absent the Medicaid expansion, will be bearing the cost of charity care even as they cope with declining revenue from other resources. The other group is private insurers, who see the growing Medicaid population as a huge profit opportunity and have been investing large amounts of money to prepare for it.
With world-renowned medical institutions such as the University of Texas and a large part of its Medicaid coverage handled by private insurers such as Amerigroup, the state's health industry is "just behind oil and gas" in size and influence, said Vivian Ho, a health economist at Rice University. "Given how much Amerigroup has to gain from a Medicaid expansion in Texas, they may be one of the most effective organizations to lobby Perry and the state legislature to fund the expansion."
It's unfolding in South Carolina, too.
A showdown is looming between Gov. Nikki Haley's administration and South Carolina's politically powerful health care industry over Haley's decision to forgo more than $13 billion in federal funds intended to extend health coverage to low-income residents.
The S.C. Hospital Association and most hospitals in the Charleston area want the state to take the money to expand Medicaid, the state and federally funded health insurance program that covers primarily low-income mothers, children and people with disabilities.
Here's the thing: Perry and Haley find it fairly easy to ignore a whole lot of voices when it comes to health care. Patients' advocates? Low-income families? Religious groups? Federal officials? Pundits and wonks? They shrug their shoulders and move on.
But for a sitting governor to ignore the needs and demands of their own hospitals is tougher, and probably unsustainable.