COVID-19 is far more deadly in minority, poor and rural communities, and some of that disparity was avoidable. By failing to expand Medicaid, states like Mississippi left millions with no access to quality and affordable health care. This has been a problem throughout the modern history of the United States but 10 years ago, there was an opportunity under the Affordable Care Act (ACA) to correct some of the inequity in access to care. Mississippi and other states could have done so at very little cost, and it would have saved so many lives over the past decade and through this crisis.

The lack of access to care for these communities is nothing new, and it is one of the factors that have led them to suffer far more from things such as diabetes, high blood pressure and heart disease. These underlying conditions have, in turn, made them particularly vulnerable to COVID-19.

Clearly, the disparate health outcomes in this country are the result of far more than a failure to expand Medicaid, and that is particularly true for racial disparities. But, by failing to expand Medicaid, an already existing program, leaders in these states choose to not take an easy, straightforward and inexpensive step to protect the most vulnerable. That is a moral failure.

‘I Aggressively Expanded Medicaid In Any Way I Could’

When I was governor of Mississippi from 1988 to 1992, I aggressively expanded Medicaid in any way I could. Mississippi was the first state to cover people up to 180 percent of the poverty level, and we substantially increased the services available. In all, we covered more than 100,000 previously uninsured Mississippians and made more health care available to those already enrolled.

It was the right thing to do for the people of Mississippi, and it was also the right thing to do financially because the federal government at the time covered more than 80 percent of the cost for Mississippi, then and now one of the nation’s poorest states. Still, far too many in Mississippi lacked access to affordable care, and in 2010 the state failed to take action to close the gap.

When the ACA became law in 2010, one of its key provisions was the expansion of Medicaid. Under the law, the federal government would cover 100 percent of the cost of this expansion for the first three years, and then it would decline gradually to 90 percent. This was an amazing deal for the states. They could cover many more of their citizens who needed it most at almost no cost. At first, this expansion was required but in 2012 when the United States Supreme Court upheld most of the ACA, it struck down the mandate that states expand Medicaid.

Fourteen states including Mississippi opted not to expand Medicaid. These states had one thing in common: they were all governed by Republicans. This group also included some of the poorest states and states with the highest percentage of people lacking health insurance.

There were no coherent reasons. It was pure, naked partisanship without regard to the suffering it would mean and a total absence of compassion.

Applying for Medicaid Hearkens Back to Literacy Tests, Jim Crow

Studies have shown that the refusal to expand Medicaid led to thousands of unnecessary deaths. Other research shows that far too many carry an avoidable crushing burden of health-care debt and that many do not seek care until complications arise. Expanding Medicaid could have partially addressed those two problems.

Another fallout of the refusal to expand Medicaid was that many hospitals in poor areas, especially in rural parts of these states, suffered greatly from the absence of Medicaid reimbursement and became financially fragile or closed entirely.

If that wasn't enough, applying for Medicaid became much more intentionally and unnecessarily complicated—hearkening back to the “literacy tests” for voting under Jim Crow. Onerous “work requirements” were designed to deny people benefits under the demonstrably false and completely demeaning theory that the problem was that people who qualify for Medicaid were unwilling to work.

These decisions to not expand Medicaid has already caused many avoidable health issues and needless deaths. The arrival of the coronavirus has shown in stark relief just how cruel and callous these actions, or lack of actions, really are. Shamefully, the United States is alone among developed countries in not providing universal health care to everyone. Even though expanding Medicaid is far from enough, it is an easy act that will save lives now.

The dying words of one coronavirus patient were "who's going to pay for it?" These words should be seared on our hearts along with the determination that no one in this country will ever have to say them or have this worry again. And even if Medicaid is expanded in these 14 states, we must act and act soon to ensure that health care is guaranteed for all through some mechanism. We will never be the country we aspire to be until we do.

Ray Mabus was Governor of Mississippi from 1988-1992 and Secretary of the U.S. Navy from 2009-2017.

Read the JFP’s coverage of COVID-19 at jacksonfreepress.com/covid19. Get more details on preventive measures here. Read about announced closings and delays in Mississippi here. Read MEMA’s advice for a COVID-19 preparedness kit here.

Email information about closings and other vital related logistical details to [email protected].

Email state reporter Nick Judin, who is covering COVID-19 in Mississippi, at [email protected] and follow him on Twitter at @nickjudin. Seyma Bayram is covering the outbreak inside the capital city and in the criminal-justice system. Email her at [email protected] and follow her on Twitter at @seymabayram0.