Amanda Gershon of Lincoln, Neb., is an advocate for Medicaid expansion in her state, where the issue is before voters in November. (Jeff Sheldon/Nebraska Appleseed)
Columnist

Without Medicaid, Amanda Gershon says, she would be dead.

But she might have avoided a near-death illness had she been covered by Medicaid earlier.

Gershon, 36, of Lincoln, Neb., suffers from ischemic colitis, chronic illnesses and pain in her hands, feet and joints. She was an example of the 63 percent of low-income adults a Government Accountability Office report said were left without needed health care in states that didn’t expand Medicaid.

"There were a lot of times where I was really unhealthy, and I just had to suffer in silence” because she couldn’t afford prescriptions and other treatment, she said by phone. “My colon shut down” in January 2016, “and at that point, the doctors told me I was not going to make it.”

But she did, making her an example of the lifesaving difference Medicaid can make. Lacking health care for so long worsened her condition, to the point that she was declared disabled — and therefore eligible for Medicaid coverage without the expansion.

Medicaid “absolutely” saved her life, Gershon said.

Now she’s pushing for Medicaid expansion in Nebraska, where a referendum to do that is on ballots in November. Idaho and Utah will vote on similar measures. They were among the states that stubbornly refused to expand Medicaid because shortsighted politicians didn’t like the Affordable Care Act, a.k.a. Obamacare. Montanans will vote on keeping their Medicaid expansion, which will end in June if they don’t.

The GAO, a nonpartisan, independent congressional research agency, didn’t publish the study now to help advocates like Gershon; it’s just that the facts are on its side.

I think this certainly makes the case for states to expand Medicaid and move forward with those expansions,” said Patrick Willard, senior director of state and national strategic partnerships at Families USA, a health-care advocacy organization. “I think that shows that there’s a strong benefit in terms of having healthier populations in the states and a healthier workforce if you expand Medicaid.”

It’s also a good deal.

“From a fiscal perspective, the case for expansion is compelling for states,” said the Commonwealth Fund, a nonprofit group that focuses on health care.

The feds now pay 94 percent of a state’s cost to expand Medicaid. That drops to 90 percent in 2020, and it will still be a good deal. “By contrast, the 17 states that have yet to expand Medicaid will leave an estimated $331 billion on the table by 2022,” Commonwealth wrote, citing Urban Institute projections.

But Republicans, eager to undo what President Barack Obama did, didn’t look at the good Obamacare has done for people like Gershon. Led by President Trump, they have bludgeoned the ACA as brutally as they could, though they failed to repeal it.

Now, GOP candidates are trying to rewrite their history because of Obamacare’s popularity, as a Fox News poll released Wednesday demonstrated. Note these Washington Post headlines about their changing positions: “Republicans race to back protections for preexisting conditions, after trying for years to gut the law that created the protections” and “What do Republicans need to win? Selective memory loss.”

Thirty-one states and the District have expanded Medicaid. No states have expanded since 2016, at least in part because of “federal efforts throughout 2017 to repeal the ACA, including full repeal of the Medicaid expansion, converting federal funding for the program to block grants, and substantial cuts to federal funding,” according to Commonwealth.

Nina Owcharenko Schaefer, a senior research fellow at the conservative Heritage Foundation, called the GAO report “a very interesting read” but pointed to its limitations. The GAO noted that its “study did not examine whether statistically significant differences in estimates of access to health care between respondents in expansion and non-expansion states were associated with the choice to expand Medicaid.”

The facts speak for themselves.

Citing a National Health Interview Survey, the GAO report shows that low-income adults in 2016 were less likely to have “any unmet medical needs” if they lived in states that expanded Medicaid.

That’s good for the individuals, their workplaces and the states' economies. The callous Republican rejection of Obamacare left people sicker because they couldn’t afford to see doctors.

“Low-income adults in expansion states were less likely to report financial barriers to needed medical care and other types of health care, such as specialty care, compared with those in non-expansion states,” the GAO said.

There are more low-income uninsured adults — about 3.7 million — in states that did not expand Medicaid than the 1.9 million in the states that did.

Meanwhile, the debate involving health care generally and Obamacare specifically reaches well beyond the states where it is on the ballot.

A Kaiser Family Foundation poll shows why Obama’s legacy makes Republicans nervous. A majority of voters “say health care is ‘very important’ in making their voting decisions for Congress this year.” The survey, released Thursday, found that “at least a quarter choose health care as the ‘most important issue,’ topping all other issues.”

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