Last week’s election leaves two questions lingering about health care: Will politicians really hear what voters said? And, what help might beleaguered patients now expect from their elected officials?
The Affordable Care Act, the central flash point of almost a decade of bitter political battles, appears stronger and more steadfast with Republicans losing the House, despite their last-minute counter-factual claims to support pillars of Obamacare like protections on pre-existing conditions, minimum- and lifetime-benefits.
Medicaid, a program expanded under the ACA to provide more and more affordable care to the poor and struggling, got a big boost, too, in the midterms. Voters, by the ballot, voted to expand its reach in the “red-red” states of Utah, Nebraska, and Idaho. The new governor in Maine will halt her predecessor’s resistance to the Medicaid expansion, according to her campaign promises. In Wisconsin and Kansas, Democratic gubernatorial candidates who also campaigned for Medicaid expansion, defeated Republicans who had opposed it.
Montanans will be figuring how and if they will stick with their Medicaid expansion, after Big Tobacco’s big spending helped to shoot down a ballot plan to use higher tobacco taxes to pay for health care for the poor. The program has been popular and in wide-spread use, so lawmakers will be under great pressure to figure how to save it.
Medicaid expansion has a less clear fate in Alaska, where the incoming GOP governor and Republican lawmakers have opposed it, and, in Georgia, where a hotly contested gubernatorial race — replete with charges of vote suppression and electoral shenanigans — has left control of that top state office in limbo.
But with the various states looking to join in the Medicaid expansion, 500,000 Americans soon will have improved health coverage. Add to that total, by the way, an estimated 400,000 Virginians, who after long wrangles between Republicans and Democrats, started enrolling for an expanded Medicaid in their state on Nov. 1.
After Tuesday’s vote, Medicaid expansions now exist in 37 states and the District of Columbia, with the likelihood of three more states joining (see map above). How long will those last holdouts, many in the South and in areas with already weak health outcomes for their residents, keep their poor residents from improved health coverage?
In California, a giant industry-spend (an estimated $110 million) and an issue of major complexity helped doom a vote on capping profits of big-money private dialysis centers, while voters easily approved a plan to boost state financial support for children’s hospitals. In Massachusetts, a proposal for the state to mandate nurse staffing ratios in hospitals went down in defeat.
Ballot measures affecting women and abortions had mixed results in Alabama, West Virginia, and Oregon.
As for marijuana use, the youth-oriented tech magazine Wired rounded up the midterm results, thusly:
Michigan voted to legalize the recreational use of cannabis, while Utah and Missouri legalized it for medical use, according to projections made late Tuesday night. (A recreational measure in North Dakota failed, though medical cannabis remains legal there.) They join 31 other states that have already gone the medical route, and nine others that have gone fully recreational.
What to make of all the outcomes from Tuesday (even as results aren’t final in many areas and may not be for a bit)?
In my practice, I see the harms that patients suffer while seeking medical services, and their struggles to access and afford safe, efficient, and excellent medical care. This is especially true now, as medical costs soar — notably due to skyrocketing expenses for prescription drugs, too many of which are unsafe.
Here’s one hot take on the midterm results — and here’s hoping it is so basic and clear that even hardened partisans can see it: Americans are terrified about their medical care and the costs of it. They know we’re all a breath away from injury or illness that prove to be catastrophic to our lives, families, friends, and co-workers. We’re all a blink away from medical-related financial calamity.
But we’re Americans, and we live in the wealthiest nation in the world. We know how to share adversity and its burdens, and we’re happy and proud to help each other in time of need, meaning we see health care as a right and not a privilege. We’re not naïve and we know big costs need to be borne by somebody. But the electorate didn’t cheer on nor vote for lawmakers who told them it was fine to give a $1.5 trillion tax cut to wealthy corporations and the richest elite, especially while insisting that, then, would mean slashes in social programs like Medicaid, Medicare, and Social Security.
As the costs of prescription drugs rise skyward, Americans have made clear they want elected officials to check Big Pharma profiteering. We’re open-minded enough, and, like it or not, we’ve experimented with marijuana, so we don’t see it as needing demonization. But we also need fact-based evidence and research so we can figure how we can ensure its safe use, especially so stoners don’t worsen a rising road toll.
The push-back, meantime, has just begun against politicians who try to con the public, whether with deficient health insurance — note that the scams in these, some major, are only beginning to proliferate, as they will — or efforts to shame and burden the poor with their use of programs like Medicaid that aim to keep them healthy and to help lift them up.
Funny thing, votes and voters matter in this country. And politicians may wish to take note that not only do falsely labeled “entitlement programs” — which taxpayers contribute to and happily support — contribute in positive fashion to Americans health, efforts like Medicaid tend to make them vote more. With 1 in 5 Americans now covered by Medicaid, and Medicare providing health coverage to more than 49 million Americans, savvy politicians should well know these aren’t “others” to disparage and cut funding for — they’re significant constituencies.
