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ATLANTA – It would have been enough for Stacey Abrams to present the expansion of Medicaid as a moral issue: the argument of health care as a human right that appeals to progressives around the world.
Instead, Ms. Abrams, a Democrat in the run for governorship of Georgia, stands by the pragmatic reasoning she's advocated for making Medicaid expansion a top priority of her campaign: this will help save the struggling rural cities of the state without breaking its budget. since the Affordable Care Act requires the federal government to pay 90% of the cost.
"Raise your hand if you refuse someone who said," Give me a dollar and I'll refund you 9 dollars, "said Ms. Abrams to a laughable laugh at the event that took place. took place earlier this month at Clark Atlanta University, a black college. "It's economically wrong, a lie on all, to say that we can not afford to expand Medicaid."
With health care dominating many mid-year campaigns this year, Medicaid's expansion has been a major topic of discussion for Democratic governorship candidates in many of the 17 states that have rejected this option, including in Florida, Kansas, Oklahoma, Tennessee and Wisconsin. But none promoted the campaign as forcefully as Abrams, 44, who would be the first black governor of the country if she were elected and the first Democrat to lead Georgia since 1998.
His momentum with the issue reflects the experience of the country's Democrats, whose argument that Republicans will not protect access to health care, especially for the sick, seems to influence voters more that all, proposals on immigration and the economy at the battle for the appointment of Judge Brett M. Kavanaugh to the Supreme Court.
Protection of protections for persons with pre-existing medical conditions, in particular constitutes a powerful closing argument for Democrats and compels Republican candidates, many of whom voted in favor of the repeal of the Affordable Care Act last year and support for a new lawsuit aimed at to invalidate it, on the defensive.
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The federal health care law has grown in popularity since it came into effect in 2010, peaking earlier this year. About half of Americans say they support it, according to the Kaiser Family Foundation's follow-up survey this month.
In defining the expansion of public health coverage by the poor for the poor smart move Mrs. Abrams, an unscrupulous liberal, hopes to be able to add enough rural voices to her column to beat Brian Kemp, her Republican opponent; a conservative Trump-style is against the expansion of Medicaid.
The polls have always shown the two elbow to elbow; Mr. Kemp's top priority for rural areas is to expand high-speed Internet access. He said the expansion of Medicaid "is costing too much and failing to succeed," warning that even the modest share of the state will divert money from public safety and security. 39; education.
The fact that Ms. Abrams has placed such a polarizing issue at the center of a conservative Deep South state – stressing its importance to rural voters who helped President Trump win Georgia in 2016 – is a reminder of the position Republicans health care advocacy this election cycle.
In this month's Kaiser poll, 56% of people in the 17 independent states have declared themselves in favor of Medicaid's expansion. An Atlanta Journal-Constitution poll in January revealed that 75% of Georgian voters, including 79% of independent voters and 51% of Republicans, were in favor of extending the program. That was significantly more than the 57% of voters who supported the expansion in Georgia during a survey conducted in 2014 by the newspaper.
In a sense, Ms. Abrams follows the pattern of Alabama's Democratic Senator, Senator Doug Jones, who also spoke of the Medicaid expansion and won an unlikely victory in last year's special election, partly because of the high participation of black rural populations.
She reports more and more research that the Medicaid expansion has improved access to regular care and medication for low-income people and has improved the financial performance of hospitals, particularly in areas with poor health care. rural. And it misses no opportunity to report that eight rural hospitals in Georgia have closed over the last decade – more than anywhere else in Texas and Tennessee – and that many others are likely to, mainly because of the decline in population and insurance payments.
In fact, Mrs. Abrams could not develop Medicaid "the first day", as she likes to say, and probably not even in her first year in office. The state legislature, which must accept it, will almost certainly remain under the control of Republicans. And leaders are likely to resist, although a number of grassroots members, particularly in rural areas whose hospitals are threatened, could begin to express more support.
But Ms. Abrams, who held the position of minority leader in the House of Representatives until last year, said that the legislature would have no choice but to go ahead. 39; accept the expansion of Medicaid before long.
"Most hospitals are closed in Republican districts and they know that there must be a solution," she said in an interview. "I think there are real political consequences, as well as moral and physical consequences that have been in place for so long. They can read the polls as well as I do.
Since 2014, the Affordable Care Act has allowed states to provide Medicaid coverage to adults whose incomes reach 138 percent of the poverty line, or $ 16,642 for a single person. Currently, adults who are neither elderly nor disabled can not qualify for Medicaid in Georgia unless they have young children and a minimal income – $ 7,480 a year for a family of three, for example. The state has more uninsured people – nearly 500,000, according to one estimate – who would become eligible for expanding Medicaid than anyone other than Texas and Florida.
Georgia's Secretary of State, Mr. Kemp, echoed outgoing Governor Nathan Deal, who described the extension of Medicaid as too expensive.
Abrams estimates the potential cost to Georgia at nearly $ 300 million a year, although offset by savings in charity and other areas; Republicans say it could exceed $ 450 million. For some rural voters, Mr. Kemp's message resonates more.
"I do not believe in an expansion of Medicaid, because free is overwhelming," said 48-year-old Debra Mullis, who runs a dog grooming business in Eastman, a town of 5,000 people surrounded by agricultural fields, about 140 km south of Atlanta. "We have to start putting these people back to work."
(The research found that most Medicaid recipients actually work part-time or full-time jobs.)
Dodge County Hospital, a 94-bed complex on the outskirts of the city, would benefit from Medicaid's expansion. Ten percent of his patients are uninsured, compared to an average of 5 percent for hospitals in the country. If Medicaid started paying for these patients, it could help Eastman avoid the fate of a nearby city that lost its hospital ten years ago and is still in shock.
"It's vital for us," said Kevin Bierschenk, hospital executive director, about the Medicaid expansion. "We are already taking care of this population; we are simply not paid for it. "
Dr. Donald Rosenbaum, the hospital's only orthopedic surgeon, worries about the cost of expanding Medicaid, but hates pushing back people in need of elective surgeries. No matter what, he says, beyond fractures. As he spoke, he was preparing to operate an uninsured man who had fractured his hand and who would end up with a marked deformity, he said, without surgery.
"As a Republican, I want to be financially cautious and I do not want to break the state later in life," he said. "But as a rural doctor, I think very frankly that we just have to do it. It's our responsibility to the community. "
Mr Rosenbaum nevertheless indicated that he would vote for Mr Kemp, as their positions on most issues were aligned.
Ms. Abrams' argument that the Medicaid expansion will save rural hospitals is somewhat confused by a plan developed by the Republican legislator to grant a dollar-for-dollar tax credit to any business or individual that donates to a country. rural hospital in difficulty. The $ 60 million program enabled dozens of hospitals to acquire up to $ 4 million each last year; Dodge County Hospital received $ 1.7 million, more than doubling its profit margin.
Ms. Abrams views the tax credit program as a "dressing", pointing out that the expansion of Medicaid would generate a lot more money – most coming from federal coffers, but not from states.
Mr. Kemp has released a health care platform earlier this month, after the Abrams campaign mocked him for including only seven words on health policy on his website. This includes increasing the tax credit program to $ 100 million.
Despite all the talk on Medicaid, several uninsured residents surveyed in Eastman this month predicted that race would be a more determinant factor for rural voters than health care or any other policy.
"There are a lot of whites here who, by God, will not just vote for a black man," said Charles Deloach, 57, a black resident of Eastman, who sells products in a corner of the city. hospital and who "most certainly" vote for Mrs. Abrams.
Nevertheless, Abrams' warnings about hospital closures may have particular resonance here, as the nearby McRae hospital closed a decade ago, forcing residents to travel 20 miles to get to the hospital. Eastman. Miranda Bush, a nurse who worked there but started at Dodge County Hospital two days after it closed, said the community had not recovered.
"Between 100 and 200 people have lost their jobs," she said. "Honestly, God was devastating."
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