Health care reform was supposed to relieve the financial strain on hospitals that have provided a lot of free charity care to poor and uninsured patients. The reform law, known as the Affordable Care Act, was expected to insure most of those patients either through expanded state Medicaid programs for the poor or through subsidized private insurance for middle-income patients, thereby funneling new revenues to hospitals that had previously absorbed the costs of uncompensated care.

In return for the new income streams, hospitals that treat large numbers of the poor and get special subsidies to defray the cost would have those subsidies reduced on the theory that they would no longer need as much help.

But after the Supreme Court ruled that the reform law could not force states to expand their Medicaid programs, 20 or more states declined to do so. That failure has hurt some big urban hospitals, because their charity care burden remains essentially the same even as their federal aid has been cut. Even in California, which has expanded its Medicaid program, public hospitals that serve the poorest patients could face a big funding shortfall in future years, according to a study just published by researchers at the University of California at Los Angeles.

There was never any question that the ACA was a compromise between healthcare for all and healthcare for some.

As many more millions receive the care they deserve, the injustice created by the GOP governors and legislatures spiteful behaviors in the red state will stand in increasingly stark contrast to the standard of care and human rights in all the other states.

As it is, in Florida, Charlene Dill’s death* of a perfectly treatable condition puts a name and face to a directly attributable consequence of Governor Rick Scott and Florida’s Republican legislature’s refusal to expand Medicaid. More such cases will surface and gain notoriety. Hopefully, these senseless tragedies will contribute to a groundswell of voter engagement in the mid-term election, especially in those states where Medicaid expansion was refused. Grassroots movements, such as Moral Monday, in North Carolina and now Georgia, need to expand to the rest of the red states. That is the only way change will take place.

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