As I See It

Tough choices ahead on Medicaid reform

Updated: 2013-11-13T01:42:57Z

By DANIEL REDWOOD

Special to The Star

I served on the Citizens and Legislators Working Group on Medicaid Eligibility and Reform, which was appointed by the Missouri House of Representatives to gather information on the state’s Medicaid system.

We held hearings last summer across the state, where anyone wishing to share experiences and opinions was welcome to testify. We heard from doctors, nurses, hospital administrators, clergy, people with disabilities, farmers, lawyers, laborers, Medicaid recipients, poor people who don’t qualify for Medicaid and many more.

Nearly everyone expressed an opinion on Medicaid expansion under the Affordable Care Act. Most favored expansion, which would bring Medicaid eligibility to 260,000 currently uninsured Missourians. For the first three years, the federal government will cover 100 percent of these costs, gradually declining to 90 percent by 2020. A Supreme Court decision gave each state the choice as to whether these citizens should have Medicaid coverage or remain uninsured.

We heard from a hardworking, uninsured farmer from southern Missouri who left home before dawn to drive for hours to our hearing in Columbia. He has heart problems, diabetes and a low income. He and his wife can’t afford the $3,000-plus monthly premiums that private insurance would cost them this year, and they don’t currently qualify for Medicaid. He implored the legislators to accept the Affordable Care Act’s Medicaid expansion because he wants to stay healthy enough to keep working the land.

We also heard from several remarkable people with severe disabilities — some paralyzed, some blind — for whom Medicaid has spelled the difference between catastrophe and a productive life. There’s one woman I will never forget. Using a wheelchair and paralyzed from the neck down, her mind is clear as a bell but her words emerge only with great effort. Despite facing almost unimaginable obstacles, she has become a community leader who devotes her life to helping others. Without Medicaid, she might not even be alive.

At least a dozen physicians from safety net clinics shared stories of their uninsured, “working poor” patients (most of whom would be covered if Missouri accepts Medicaid expansion) who can’t afford the medicines or other treatments prescribed for their diabetes, heart disease, hypertension or chronic pain. As a result, they spiral downward, suffering greatly as their previously manageable ailments become unmanageable (such as treatable diabetes descending into kidney failure) , at which point their now-severe disabilities allow them to finally qualify for Medicaid, but too late to regain their health.

The Missouri Hospital Association strongly supports Medicaid expansion. Several hospital administrators explained to us that their institutions are under severe financial stress from providing millions of dollars of uncompensated care to the uninsured, much of it delivered in their emergency departments to people who would be far better served by preventive primary care. Medicaid expansion was intended by Congress as a key element in a comprehensive approach to encourage prevention and primary care.

For me, the most surprising testimony came from a hospital administrator from the Ozarks, whose company operates facilities in both Missouri and Arkansas. Because Missouri at this point is not moving forward with Medicaid expansion but Arkansas is, his hospital system has felt compelled to lay off employees in Missouri while hiring new ones in Arkansas.

We stand at a crossroads, facing stark choices about the values we want our nation to uphold. If you believe, as I do, that we need a compassionate and well-targeted approach, including Medicaid expansion, to bring greater health care access to more citizens, now is the time to let your legislators know.

Daniel Redwood, a doctor of chiropractic, is a professor at Cleveland Chiropractic College in Kansas City. He lives in Overland Park.

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