The long history of white Southern politicians opposing health care expansion

Southern politicians have a long history of opposing efforts to provide their constituents with government-sponsored health care.

In 1947, President Harry Truman proposed legislation that would essentially provide for universal health care paid for by fees and taxes. Keep in mind that healthcare options for working people were even worse back then than they are today because fewer people had employer-based health insurance.

Truman’s proposal was partially rejected by Southern Democrats in the US House and Senate. Economics Nobel laureate Paul Krugman wrote in his book The Conscience of a Liberal that Southern politicians rejected the Democratic president’s plan because they feared it would lead to a government mandate to integrate hospitals.

“Keeping blacks out of white hospitals was more important to Southern politicians than providing poor whites with the means to receive medical treatment,” Krugman wrote.

As it turns out, Southern politicians still aren’t crazy about government-sponsored health insurance.

A quick look at a map of states that have and have not expanded Medicaid is intriguing. Of the 11 states that have not expanded Medicaid, eight (including Texas) are Southern.

The map of non-expansion states actually closely resembles the Southeastern Conference collegiate sports league footprint, with the exception of Louisiana, Arkansas, Kentucky, and Missouri. These four states have expanded Medicaid. Granted, most would say Missouri isn’t a Southern state, but it is in the SEC.

In any case, it is the SEC states, led by Southern politicians, now Republican Southern politicians, who are once again resisting efforts to expand government-sponsored health care to help their poor constituents.

Of course, hospitals are no longer separate. According to Krugman, they were incorporated in the 1960s when another government-sponsored program was introduced: Medicare, which provides health care to the elderly.

While various studies have found that the largest percentage of people who would benefit from expanding Medicaid are people of color, it’s important to note that there are many white citizens who would also benefit.

The Medicaid extension, permitted under the Patient Protection and Affordable Care Act, provides health coverage primarily for the working poor — people who earn up to 138% of the federal poverty line, or $18,754 per year for an individual. In Mississippi, the traditional Medicaid program generally covers poor pregnant women, poor children, certain groups of poor retirees, and the disabled, but not the working poor.

The federal government pays the majority of healthcare costs for those expanding Medicaid. When Southern politicians express their opposition to Medicaid expansion, they often simply state that they are “opposed to Obamacare,” as if that were reason enough to be opposed.

“I oppose Obamacare’s expansion in Mississippi. I oppose Obamacare’s expansion into Mississippi. I oppose Obamacare’s expansion into Mississippi. I don’t know how many ways I can explain this to you,” Republican Gov. Tate Reeves responded to reporters’ questions.

When the country’s only black president, Barack Obama, passed the Affordable Care Act through Congress in 2010, almost all Republicans opposed “Obamacare.” But now solid Republican states like Montana, North Dakota, Utah and Idaho have embraced Medicaid expansion. In Republican-controlled South Dakota, voters just accepted a ballot initiative to accept the Medicaid expansion. For the most part, it’s just Southern politicians who are avoiding Medicaid expansion.

John Bell Williams also opposed health care expansion when he represented Mississippi in the US House of Representatives. As a congressman, he voted against Democratic President Lyndon Johnson’s plan to establish a Medicaid program for a small segment of the underprivileged.

But as governor, Williams later called a special session in 1969 and asked the legislature to vote on the Medicaid program.

Speaking to the Legislature, Williams said: “Let’s not give in to the misconception that we can escape the burden of caring for these unfortunate people. Our society has always taken this responsibility through the instrument of government and I am sure it always will.”

Williams went on to say that the state cannot afford to reject a federal health care program that only requires the state to provide 20% of the appropriate funding. He spoke of the economic impact this would have on the state.

“The simple fact is that someone is paying for health services and we have to decide who is going to do it and how,” he explained.

The special session lasted from July 22 to October 11. In the end, the Mississippi legislature voted in favor of the program, proving that Southern politicians were not always opposed to improving health care for their poor constituents.

Whether that will happen with the Medicaid expansion remains to be seen.

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