Dobbs heightens the moral imperative to close Medicaid coverage gaps

Congress has a once-in-a-decade opportunity to complete the work of the Affordable Care Act and fulfill a promise made 12 years ago to 2.2 million people who live in states that have refused to expand Medicaid and who live without access to healthcare.

Sixty percent of those in the coverage gap are people of color who have been excluded from coverage for generations. Closing the Medicaid coverage gap is the single most important step we as a nation can take to achieve greater racial equity in health.

As faith leaders, we recognize that healthcare is essential to life and thus believe access to quality, affordable care should not be a privilege reserved for those who can afford it. In Proverbs 31:9, we are reminded of our responsibility to “Speak up, judge righteously, champion the poor and the needy.” The federal government must step in and finish the Affordable Care Act for the sake of life.

The urgency to act significantly increased last month when the Supreme Court struck down the federal right to abortion in the Dobbs decision. Each of our faith traditions challenged the decision which forces a woman to maintain a pregnancy against her will. Our religious teachings hold that pregnant people must have the agency to make decisions for themselves and their families.

It is ironic that many of the states that have refused to provide lifesaving healthcare services to those living in poverty through the Medicaid expansion are the same who have or will ban abortion access under the motto of being “pro-life.” A policy that denies comprehensive health coverage to low-income people gives way to death. Failure to expand comprehensive coverage to people of reproductive age risks the lives of mothers and children and is morally bankrupt.

There are more than 800,000 women of reproductive age (19-49) in the coverage gap; 29 percent are Black and 33 percent are Latina. These people are uninsured without any pathway to affordable health coverage. If they become pregnant, they can apply for pregnancy coverage, but it is not guaranteed until they are determined eligible. This means they wouldn’t be covered before they became pregnant or during the first months of pregnancy. They risk missing out on services such as preconception health counseling and early prenatal care.

Most of the non-expansion states are in the South, a region where over half of the country’s Black population lives, which has high rates of maternal mortality, and where states are moving most rapidly to eliminate access to abortion in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. Black women are already about three times more likely to die from pregnancy-related complications than white women. Fully addressing maternal mortality and morbidity requires attention to people’s health before and between pregnancies. Having care in these periods allows for identification and treatment of risk factors such as hypertension and diabetes as well as for preconception health care services such as counseling and prescriptions for folic acid, which reduces birth defects. Other essential reproductive health services such as cervical cancer and STD screenings also decrease pregnancy risk factors. Filling the coverage gap must be part of a comprehensive strategy to address the Black maternal health crisis.

Jewish tradition is clear about our responsibility to provide health care for all people. Maimonides, a revered Jewish scholar, teaches, “it is obligatory from the Torah for the physician to heal the sick.” Furthermore, providing health care is not just an obligation of the doctor, but for society as well (Mishneh Torah, Hilchot De’ot IV:23).

In the Christian tradition, Jesus was asked what the greatest religious commandment is. He responded that we are to love God completely and freely and we are called to love our neighbors as ourselves. Loving our neighbors includes acting in solidarity to promote their well-being.

Similarly, within the Muslim tradition, God states in the Qu’ran, “None of you [believers] will attain true piety unless you give out of what you cherish” (3:92). As human beings, we cherish and value our health, and the ability to seek and obtain healthcare that produces the best health outcomes for ourselves and our loved ones. Our faith guides us to ensure that this same opportunity is available to all those around us.

Twelve years is long too long to wait for healthcare justice. Congress and President Biden must choose justice by closing the coverage gap in the forthcoming economic reconciliation legislation. Action will protect the health and well-being of all people, including those of reproductive age who are made vulnerable by the Dobbs decision.

Failure to provide lifesaving healthcare must not be an option.

Ghada Khan, MPH, DrPH, is the executive director of the American Muslim Health Professionals. Rev. Susan Henry-Crowe, D.Div., is the general secretary of the General Board of Church and Society for the United Methodist Church. Rabbi Jonah Pesner is senior vice president of the Union for Reform Judaism and director of the Religious Action Center of Reform Judaism.

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