States balk at Medicaid expansion

Social Service Sr. Simone Campbell speaks at Mount Marty College in Yankton, S.D., Sept. 12. (Courtesy of Mount Marty College)
Social Service Sr. Simone Campbell speaks at Mount Marty College in Yankton, S.D., Sept. 12. (Courtesy of Mount Marty College)

by Nathan Johnson

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As opening day for the new health care law approaches, almost half the states in the country have not agreed to go along with a provision to expand their Medicaid programs to include more of their uninsured poor. Social Service Sr. Simone Campbell wants voters to put pressure on those governors and legislators to change their minds about balking at the Medicaid expansion.

"It's straight party politics," she said during a speech Sept. 12 at Mount Marty College in Yankton. "Everyone is positioning for the 2014 election. We people of faith have got to stand up."

Campbell is executive director of NETWORK, a Catholic social justice organization based in Washington that educates, lobbies and organizes in support of economic and social transformation. She recently has gained national attention for her support of the new Affordable Care Act even though the U.S. Conference of Catholic Bishops continues to oppose it.

Her lecture at the Benedictine college focused explicitly on the decision by South Dakota's Republican Gov.

Dennis Daugaard to decline to expand Medicaid eligibility to an estimated 48,500 people in the state, mostly adults without children.

But the issue affects people across the country. Under the health care law, which was enacted in 2010 and most of which goes into effect in January, states were expected to offer Medicaid to anyone making 138 percent of the poverty level -- $15,451 for a single person or $31,809 for a family of four -- or less. The federal government would cover the costs of the additional enrollees by almost 100 percent at first, with that level dropping over time to 90 percent. When it upheld the law in June 2012, however, the U.S. Supreme Court also ruled that it was unconstitutional to force states to go along with the expansion.

As of Sept. 16, governors or legislatures in 22 states were not going ahead with the expansion and a few others were still up in the air, according to the Kaiser Family Foundation website ( Without that additional support, millions of people would not be eligible to receive health care coverage, even through the state and federal insurance exchanges. Enrollment through those exchanges opens Oct. 1.

That is just one impediment to the law working the way it was intended. Supporters are scrambling to get people to sign up for the exchanges amid a growing opposition to the law. Republicans continue to rail against it and now want to try to ban any government funding toward implementing it. Even though Senate Democrats will not allow that to happen, the mere act of a vote leaves people thinking the law is dead. According to a recent USA Today/Pew Research Center poll, 53 percent of Americans surveyed disapprove of the law and 47 percent say it will have a negative effect on the nation in years to come.

Moreover, the nation's Catholic bishops continue to complain about a provision that requires most employer-based insurance plans to cover contraceptive services. Some religious organizations are exempt from this rule, but a number of Catholic groups say those exemptions are not enough.

In a Sept. 17 letter to the nation's bishops, New York Cardinal Timothy Dolan said the 36 members of the U.S. bishops conference's administrative committee were "unanimous in their resolve" to keep fighting the mandate.

"They asked me to convey that firm resolve to you," Dolan, president of the bishops conference, wrote in the letter. "If there's any perception that our dedication to this fight is flagging, that's dead wrong."

Other groups, such as the Catholic Health Association, led by Charity Sr. Carol Keehan, have said the administration has addressed their concerns in revisions to the rule.

"We have not ourselves as bishops been able to arrive at the same conclusion," Dolan said during a Sept. 11 press conference. "There's no way that we're ready to say that yet."

He also said while the bishops look to the health association for expertise, "they are not the official teachers in faith and morals in the church."

In remarks to local media in South Dakota, Campbell also said she accepted the Obama administration's changes to the contraception mandate and criticized the bishops for not doing the same.

"The bishops persist in saying it isn't sufficient," she said. "They keep moving the goalpost. It's a question of giving people true information and not just fear."

In a letter to his clergy, Bishop Paul Swain of Sioux Falls, S.D., called Campbell's position on the issue "both personal and wrong."

"Those who seek to know what the church really teaches should look to the statements of the bishops," he said.

Joseph Benoit, president of Mount Marty College, said he was "a little disappointed" when he saw the letter because Swain had approved Campbell's appearance in the spring.

In her lecture at Mount Marty, Campbell questioned why Daugaard or anyone else would want to turn down Medicaid money she says will assist low-income individuals, as well as hospitals that provide charity care.

She said it is easy to think of being pro-life in terms of the issue of abortion, which she said amounts to only a pro-birth stance. Americans must look beyond that issue to be truly pro-life, she said.

"I think we need to look at what Jesus did in the Gospel," Campbell told the audience. "He said that where we are called is to those in the margins, to those who suffer. That is the pro-life stance that I think Jesus calls us to -- to make sure all are included, not only in our prayer but also in our active care. In a big society like ours, it is not possible for charity alone to fill up that gap."

At the beginning of her lecture, Campbell called on volunteers to create a human bar graph showing the audience how far the income increases of the top 5 percent of earners outstripped all others between 1979 and 2009. Those on the bottom of the income ladder actually saw their incomes decline.

"For me, it helps explain why it's difficult for folks who are [in the top 5 percent of the income ladder] to understand the struggle [of those at the bottom]," Campbell said. "Because what happens is, not only are they economically removed, but at [the top of the income ladder], they can afford gated communities, private police, private schools, private medical care.

"The distance that is created leads to a lack of comprehension, lack of understanding, lack of empathy," she said.

Campbell said the Affordable Care Act is not perfect and needs work.

But, she said, "it's better than what we have now."

[Nathan Johnson is a journalist in Yankton, S.D. NCR national correspondent Joshua J. McElwee contributed to this story.]

A version of this story appeared in the Sept 27-Oct 10, 2013 print issue under the headline: States balk at Medicaid expansion.

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