You could draw a triangle from Texas to West Virginia to Georgia and in that area, you would have the highest rates of diabetes, obesity and chronic illness in the country, said Dr. Kenneth Thorpe, a chronic disease expert at Emory University in Atlanta.
High poverty typically has dragged down the Southern rankings. So have risky health choices, such as poor diet and smoking. But so can the impact of public policy decisions, such as whether the social benefits of the Medicaid expansion are worth the costs.
A new report by the philanthropic Robert Wood Johnson Foundation finds the nine anti-expansion Southern states among the 21 that would benefit most from broader Medicaid eligibility, based on their higher levels of working poor adults who struggle with medical bills.
"I think its very foolish from a health perspective, from an economic perspective, for these states to be turning this down, said Joan Alker, a co-executive director of the Center for Children and Families at Georgetown University. Its playing politics in the worst sense of the word. There are no big interests that are against this. The hospitals are for it. The managed care industry is for it. Most of the employer groups are for it. The opposition is purely ideological. Its the tea party faction of the Republican Party.
The nine Southern anti-expansion states arent the only opponents. Republican governors in six other states Maine, Pennsylvania, Michigan, South Dakota, Iowa and Idaho have said they wont participate, either, although pressure is mounting for them to reconsider.
The Republican governors of Florida and Arizona already have dropped their opposition.
Some states such as Arkansas, Oklahoma, Tennessee and Nebraska, are inquiring whether health care overhaul dollars may be used to expand private coverage rather than Medicaid.
Still, nearly two-thirds of the 15 governors who oppose bringing more people into Medicaid are in the South, where low-income adults now must earn far below the poverty line to be eligible for the program. In Mississippi, parents with dependent children qualify only if their net income is less than 29 percent of the federal poverty level.
Thats about $6,830 for a family of four.
From a social or humanitarian perspective, you could argue Medicaid expansion is a winner. But from a purely financial perspective, its clearly a loser, said Charles Blahous, a senior research fellow at the Mercatus Center, a market-oriented research center at George Mason University in Virginia.
Next to education, Medicaid is the largest expenditure for most states, and many Republican governors fear that an expanded Medicaid base would crowd out spending for other vital services.
I continue to believe that Mississippi should not expand Medicaid because doing so would result in tax increases for hardworking Mississippians or cuts to critical spending in areas like education, public safety and economic development, Gov. Phil Bryant said in a recent statement.
From 2003 to 2012, Mississippi spent more than $9 billion on Medicaid and the states poor health indicators have remained unchanged or worsened, Bryant spokesman Mick Bullock said.
The data show that throwing money at the issue money the state does not have is not working, Bullock said in an email. So why would we throw even more money we dont have at the issue and expect some miraculous change in outcomes?