[Episcopal News Service] As the implementation of the Patient Care and Affordable Health Care Act begins to take shape, congregations in Louisiana and Ohio are fighting to continue meeting the needs of the medically uninsured. That includes pushing government officials to sign on to the expansion of Medicaid under the plan, slated for full deployment in 2014.
The Affordable Care Act is designed to help the uninsured buy insurance through a government-subsidized program. In 2012, the U.S. Supreme Court ruled that states had the right to reject expansion of Medicaid, the joint federal-state health insurance program for lower-income Americans. But the court upheld a provision in the health-care act mandating that the uninsured buy some form of health insurance or face paying a penalty.
Louisiana, Texas, Oklahoma, Alabama, Mississippi, North Carolina, South Carolina, South Dakota and Maine are among those states that have Medicaid expansion.
The Affordable Care Act is a signature program of the Obama administration and is widely supported by Democrats. In states that accept the Medicaid expansion option, the federal government pays the full cost to implement the program for three years, after which states are required to pay 10 percent of the costs.
How Medicaid expansion will affect medical ministries in states that have opted in, however, remains a question.
The impact will be different in every state, said Matthew Ellis, executive director of National Episcopal Health Ministries.
“There are so many variables. It’s not just the provisions of the [health-care act], it’s also some personalities and political views involved.”
The Episcopal Church, through General Convention legislation, has called for universal access to health care, and 94 percent of the church’s domestic dioceses participate in the denominational health plan. Resolution A040, approved by General Convention in Indianapolis in 2012, directed that “every member of the Episcopal Church make a moral commitment to health care for all, by actively supporting health care reform in the United States.”
Uncompensated health-care costs increase denominational health and insurance costs, said the Very Rev. Tracey Lind, dean of Trinity Cathedral in Cleveland and a member of the board of trustees of the Church Pension Fund.
Recently, Lind was part of a strong lobbying effort in Ohio led by the Greater Cleveland Congregations, a coalition 40 churches, synagogues and mosques, that contributed to Gov. John Kasich’s decision to add Medicaid expansion to next year’s budget.
“Medicaid expansion is vital, not only because it provides health insurance, but because it brings the uninsured into primary health care and out of emergency rooms,” Lind said. “The economic impact will bring tens of thousands jobs and millions of dollars to the state, because health care is one of the principal economic drivers.”
Members of Greater Cleveland Congregations met with Kasich and legislators in late January to underscore the importance of Medicaid expansion to the state and their congregations, said Lind. “It got clear very quickly that we could have an impact on health care in Ohio when it came to Medicaid.”
For example, she said, there are empty nesters aged 45-60 in her congregation who have been laid off since the last recession. Unable to find jobs, they have run out of severance benefits, saving and investments; are uninsured; and are too young to qualify for Medicare, she said.
“There are uninsured members in all the congregations in the greater Cleveland area,” she said.
During a press briefing in early February, Kasich a Republican, outlined Ohio’s $63 billion state budget, including funds for the expansion, according to news reports.
“It makes sense for the State of Ohio,” said Kasich, adding that the expansion would cover some 366,000 uninsured Ohioans.
Within recent weeks eight other Republican governors, including Jan Brewer of Arizona, Scott Walker of Wisconsin, Rick Scott of Florida and Chris Christie of New Jersey have reconsidered adding portions of the expanded care to their state budgets.
Not so in Louisiana, where St. Anna’s Medical Mission was one of 19 New Orleans health-care providers to send Gov. Bobby Jindal a letter asking him to reverse his rejection of Medicaid expansion in the state. A Kaiser Family Foundation study calculates that one-fifth of Louisiana’s population lacks health insurance.
Jindal, a Republican, has said the expansion would be “too costly” and allow the government to intrude into people’s private lives.
“It would be a burden on Louisiana’s budget,” Jindal wrote in a Jan. 28 opinion piece in The Washington Post. After 2016, states would be required to pay 10 percent of the costs for Medicaid expansion, which would total some $3.7 billion over the first decade, he wrote.
St. Anna’s, which is a mission of St. Anna’s Episcopal Church, was established in the aftermath of Hurricane Katrina in 2005.
At that time, New Orleans resident Diana Meyers, St. Anna’s community wellness director and registered nurse, began to see the need for on-site health care and mental-health counseling for residents in the city’s devastated neighborhoods.
The ministry works with local clinics to provide basic health screenings, testing and medical advocacy, and it directs patients to clinics where they can establish a primary-care routine for themselves. This safety net of clinics attempts to keep patients from using local hospital emergency rooms for routine treatments, like for coughs or the flu.
“The health-care layout has changed dramatically since the storm in a good way,” Meyers said. “There are more neighborhood clinics, and they’re working together.”
However, the “Katrina effect” of generous financial donations to assist recovery has almost dried up, so continuing to provide indigent health care depends on working together, said Meyers.
The rejection of Medicaid expansion would not immediately affect St. Anna’s because it is working on different options to strengthen and maintain its partnerships with local clinics, she said. But, in the long run, government-subsidized health insurance would reduce some of the burden on St. Anna’s and similar clinics, she said.
“We don’t have a continuous funding stream,” said Meyers. “With no large donations, corporate or foundations, we go hand to mouth.”
St. Anna’s previously has explored applying for Medicaid grants, but doing so would involve large bureaucratic costs and creates “a moral dilemma” for the nonprofit organization that has a $250,000 operating budget and treats everyone free of charge (though they do have a donation box), Meyers said.
“Do we treat everyone for free, or do we begin to charge [a] co-pay for Medicaid? People have a hard time understanding there is no free health care, everyone charges,” she said.
— Mario Villafuerte is a Shreveport, Louisiana-based freelance journalist and a member of St. Mark’s Episcopal Cathedral.