Tuesday, September 30, 2014

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Putting ideology above lives

Studies have forecast that states' refusal to expand Medicaid will mean thousands of preventable deaths each year, and the victims aren't just the poor.

Posted on July 29, 2014 at 5:42 p.m.

WASHINGTON — On July 1, the hospital in rural Belhaven, N.C., closed — a victim, in part, of the decision by the state's governor and legislature to reject the expansion of Medicaid under Obamacare.

Six days later, 48-year-old Portia Gibbs, a local resident, had a heart attack. The medevac to take her to the next-nearest hospital (as many as 84 miles away, depending on where you live) didn't get there in time.

"She spent the last hour of her life in a parking lot at a high school waiting for a helicopter," Belhaven's mayor, Adam O'Neal, said outside the U.S. Capitol on Monday, holding a framed photograph of Gibbs.

A week after Gibbs' death, O'Neal began a 15-day, 273-mile walk to Washington to draw attention to the outrage in Belhaven, which he blames on the combination of an "immoral" hospital operator and the failure of Republican leaders in his state to accept the new Medicaid funding the hospital needed to stay afloat.

What makes the mayor's journey all the more compelling is he's a Southerner and a Republican officeholder who has conservative views on abortion, taxes, guns — "you name it," he told me. But ideology and party loyalty have limits. "I'm a pretty conservative guy, but this is a matter of people dying," he said.

Republicans nationwide have abandoned any consideration of offering an alternative to the Affordable Care Act, figuring that their complaints about President Obama's selective implementation of the law, and lingering unease about the legislation itself, will be enough to motivate conservative voters in November. But as O'Neal points out, this political calculation has a moral flaw.

"If the governor and the legislature don't want to accept Medicaid expansion, they need to come up with another program to assure that rural hospitals don't close," the 45-year-old mayor said. Otherwise, he continued, "they're allowing people to die to prove a point. That is wrong, and I'm not going to be a party to that."

O'Neal is no fan of Obamacare, but during his journey, he sent a letter to Obama asking for a meeting. "I am a conservative Republican and I understand some of the suspicions political leaders in my party have that Washington won't keep its promises," he wrote. "But those concerns do not trump the need to maintain health services in struggling communities. Rural citizens dying should not be soldiers of the South's defiance to the new health care law."

Inexplicably, the White House didn't reach out to O'Neal. The mayor did, however, get a place on the calendar of Sen. Kay Hagan, D-N.C., who is facing a strong challenge from Thom Tillis, the state House speaker who helped block the Medicaid expansion.

The law cuts subsidies to hospitals that treat the uninsured, under the assumption that the gap would be offset by increased Medicaid funding. But half the states rejected the federal Medicaid money. On top of that, small hospitals such as Belhaven's shuttered facility, Vidant Pungo Hospital, face market pressure to consolidate.

Studies have forecast that states' refusal to expand Medicaid will mean thousands of preventable deaths each year, and the victims aren't just the poor. O'Neal said Portia Gibbs had health insurance — but it didn't do her any good without a hospital.

"Ladies like Portia Gibbs are dying all across this country right now," O'Neal, tanner and a bit less pudgy than when he began his trek, told an audience outside the Capitol. In his Southern drawl, the mayor introduced Justin, the deceased woman's son, and promised that "we're going to fight as hard as we can to keep this from happening again."

O'Neal arrived on Capitol Hill carrying his hiking pole and wearing trail shoes, shorts and a "Save our Hospital" T-shirt. He was accompanied by about 250 supporters, most affiliated with labor unions, and by civil rights leaders.

Crystal Price and her young son joined the mayor on the state. Price, 27 and an employee at Wendy's, has no health coverage and spoke tearfully about her cervical cancer. "They don't want to expand Medicaid, so families like mine ... have to decide if we're going to pay for our children's health care or our own," she said. "How many have to bury their loved ones, and how many children like my own will have to grow up without a parent because you want more money in your pockets?"

For O'Neal, any ideological doubts about Obamacare are dwarfed by the disgrace of a young working mother unable to get cancer treatment.

"I mean, that's wrong," he said. "Conservatives — everybody — should think that's wrong."

Follow Dana Milbank on Twitter, @Milbank.

(c) 2014, Washington Post Writers Group

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