The dominoes are falling. Last week, conservative Republican governors in Ohio and Michigan joined the parade of state leaders admitting the U.S. has a major problem in the way it provides healthcare for the uninsured.
The public, at least if we're to judge by the results of the November election, endorsed the Patient Protection and Affordable Care Act as a reasonable approach to solving this festering social blight, which has left the U.S.—more than half a century after national health plans were adopted in western Europe—as the only advanced industrial nation without universal coverage for all of its citizens.
The issue confronting governors in the wake of the U.S. Supreme Court's decision last June is whether to expand Medicaid to cover people earning up to 138% of the federal poverty level. These are people who, though working, do not get access to affordable insurance on the job and are too poor to buy coverage in the private marketplace, even with federal subsidies that will be provided through the insurance exchanges set up under the law.
The economic consequences of failing to provide coverage to these near-poor Americans are well-known but bear repeating. The uninsured avoid routine care, which means they do not get access to the cost-effective preventive care that would keep them away from hospital emergency rooms. When they seek out care, they are often far sicker than they would have been under the care of a primary-care physician. Or, they make the emergency room their first stop when they need routine care (like this winter for a serious bout of the flu).