This is an IJR Blue-reported opinion response to IJR’s original investigative piece, “State-to-State Disparities Leave People Fighting for Health Care.” To see a proposed solution from the other side of the aisle, you can find the IJR Red reported opinion response here.
Not all Medicare and Medicaid is created equal. Richer states have the most generous coverage for their residents. The care you can receive from the government in the United States depends on where you live, and less prosperous and more rural states are feeling that burden.
A study by WalletHub ranked states’ health care from best to worst and found that Vermont landed in the number one position, while Louisiana came last.
When IJR interviewed families living in those respective states, the differences were obvious. One family in Vermont got all of their bills covered when their infant was diagnosed with a debilitating disease, while a family in Louisiana was paying tens of thousands of dollars for their kids’ care. Their doctor even recommended they leave the state.
The reason behind these discrepancies boils down to funding. Vermont carries a surplus of more than $55 million, while Louisiana’s state budget is $648 million in the red. Because states can decide who can or can’t get assistance from Medicare and Medicaid programs, states with struggling budgets simply can’t put out the cash.
According to a 2017 report from Vox, all states must cover children and pregnant women below a certain income, low-income seniors, and people with disabilities. But after that, it’s up to the states, and that’s where discrepancies arise.
For example, a single, nondisabled person living in California who makes $10,000 a year qualifies for Medi-Cal, the state’s version of Medicaid. That same person wouldn’t qualify for Medicaid if they lived in Texas. Texas only covers low-income adults who have disabilities or children.
Services also vary; some states won’t cover dental, vision, or hospice care under their version of Medicare.
While the GOP proposes free-market approaches to health care, a solution from the left side of the aisle is Medicare for All, also known as universal health care. It’s an idea that may have seemed radical a decade ago but is hitting the mainstream hard by taking the front seat of issues covered by progressive Democratic candidates in recent elections.
Sen. Bernie Sanders (I-Vt.) used Medicare for All as one of his main platforms during his 2016 presidential run.
Sanders acknowledged the differences in state-to-state coverage on his campaign website: “Two patients with the same condition may get very different care depending on where they live, the health insurance they have and what their insurance covers.”
The idea has since been taken up by many progressive lawmakers and candidates, notably New York congressional candidate Alexandria Ocasio-Cortez. She endorses the Expanded and Improved Medicare for All Act proposed by Rep. John Conyers (D-Mich.), which is similar to Sanders’ proposal except it’s voluntary and still allows private health insurers to stick around.
The irony is that if Medicare for All works as progressives intend it to, conservative states may have the most to gain.
From the WalletHub study, the trend is that conservative-leaning states, especially in the southern region, don’t rank as high as liberal-leaning states.
The following graphic ranks all 50 states and the District of Columbia according to the study and colored how they voted in the 2016 presidential election:
While there’s pushback from Republican lawmakers, Medicare for All is actually fairly popular among GOP voters. In a poll conducted by Reuters in August of this year, 51.9 percent of Republicans supported Medicare for All, while only 37.4 percent opposed. The rest were undecided. In total, 70.1 percent of Americans supported Medicare for All.
The problem for Republican lawmakers is that the Medicare for All plans require an increase of taxes. But the majority of the tax raises would happen to the top 5 percent of earners in the country. Progressives also argue that out-of-pocket costs would decrease.
Conyer’s House bill also lets private insurers stay in competition, which could alleviate a worry from Republican lawmakers.
A complete overhaul of the country’s health care system won’t be easy, and it won’t be cheap. But if the Democrat-backed Medicare for All system ever becomes law, it could have the most dramatic positive impact on Republican-voting states.