BILOXI, Miss. -- Michael Whites high blood pressure is acting up again.
The 51-year-old casino janitor has recurring seizures and recently awoke in an ambulance after passing out at a bus stop.
It doesnt hit me suddenly, White said. It creeps up on me. I get this feeling like Im outside of my own body.
If White had insurance, hed be under the care of a primary physician and taking medications regularly. But he cant afford job-based health insurance on his $8-an-hour wage and he earns too much to qualify for Medicaid, the state-federal health plan for poor people and those with disabilities.
So White takes his place in a growing line of uninsured patients outside the Bethel Free Health Clinic on the grounds of a federal housing project in Biloxi, Miss. Its his off day, so hes in no rush. He just wants to be one of the dozen or so patients lucky enough to see a doctor.
White is one of 300,000 Mississippians whod likely qualify for Medicaid next year when the health care overhaul extends coverage to adults who earn up to 138 percent of the federal poverty level. Thats nearly $16,000 a year for an individual in 2013, or roughly $32,500 for a family of four.
But Mississippi and eight other contiguous Southern states, all led by Republican governors, have decided not to implement the Medicaid expansion, even though the federal government has pledged to pay all medical costs for the newly eligible enrollees in 2014, 2015 and 2016 and no less than 90 percent of their costs thereafter.
All of them Tennessee, North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, Texas and Oklahoma say they cant afford it under those terms.
The wall of Southern opposition is one of the last major obstacles to President Barack Obamas goal of universal health coverage for all Americans. If it remains intact, nearly 5 million of the newly eligible wont have Medicaid coverage in 2022, according to estimates by the nonpartisan Kaiser Family Foundation, a health care research group.
Besides shared borders and conservative political leadership, most of the nine states have something else in common: By a host of measures from obesity to infant mortality all but North Carolina and Georgia are among the unhealthiest in the nation, according to the 2012 edition of Americas Health Rankings.
Mississippi and Louisiana tie for dead last among all states in the health of its residents, according to the annual report by the United Health Foundation , a nonprofit arm of the insurer UnitedHealth Group. Neither state has finished higher than 48th since the rankings began in 1990.
Louisiana and Mississippi are obviously the two states in the nation that are facing the most serious socioeconomic challenges, so its not hard to understand why they score near the bottom each year, said Dr. Reed Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group.
Also faring poorly were South Carolina, ranked 46th, and Alabama, which ranked 45th after moving up three spots from 2011. Oklahoma, Texas and Tennessee finished 43rd, 40th and 39th, respectively.
Of the nine Southern states to reject the Medicaid expansion, only North Carolina, at 33rd, and Georgia, at 36th, ranked outside the bottom 12 states.