Miami Herald: Medicaid expansion saves lives, money

The Miami Herald
Posted on Mon, Apr. 15, 2013
Medicaid expansion saves lives, money
The Medicaid expansion debate raging in Tallahassee can seem pretty abstract at times, as lawmakers consider whether and how to move billions of federal dollars to help millions of people access quality healthcare in communities across Florida.

But here’s a fact that isn’t abstract at all — Medicaid expansion could mean $35 million extra dollars flowing to Jackson Health System every year. That’s according to JHS CEO Carlos Migoya. He wrote a memo on the subject, noting that the issue is complicated for Jackson because of unanswered questions about changes to reimbursement rates and other factors.

The nurses, doctors and healthcare professionals who work at Jackson support expansion because it will help our hard-working citizens who make just a little too much to get Medicaid coverage, yet not enough to afford private insurance. Expansion would mean that a family of three making less than $26,000 a year could get covered. It would cover more than 200,000 residents in Miami-Dade alone.
Many of us who work on the front lines of our public hospital have stories about patients in this situation who wait until they have a health crisis to finally see a doctor, usually in our ERs, where the cost of treating them is five times higher than it would be if they could access primary care. We treat them, and then send them back home, where they have limited, if any, access to prevention and follow up care. It is an expensive and unhealthy cycle.

I have heard so many stories from my colleagues about patients they wish they could help escape this cycle.
• The young single woman with lupus who uses the emergency room to treat her flare-ups because she has no other option.
• A young man who came in with a testicular mass only when it got so bad he couldn’t go to work.
• The 62-year-old with chronic obstructive pulmonary disease who is not quite old enough to qualify for Medicare, not quite ill enough to qualify for disability, and makes just a little too much to get Medicaid.

The stories about cancer patients whose lives are shortened by their lack of access to a continuum of care would break your heart.

Expanding healthcare is a major step toward changing the paradigm from “sickness” care to “wellness” care.Medicaid expansion will allow more access to healthcare, thus shifting the cost curve. Prevention and wellness are much more cost-effective than emergency rooms, not to mention the improvement in health and quality of life for our citizens.

There’s a reason for the old adage “an ounce of prevention is worth a pound of cure.”
Currently, we won’t give an uninsured diabetic patient access to insulin, but we will surgically remove his leg in 10 years when his health has declined to the point where it is a matter of life or death.
Guess who pays for that? The taxpayer does. Why wouldn’t we pay a small amount upfront to keep this patient healthy and our long-term costs down? That is the real question facing our legislators in Tallahassee.

Expanding access to quality, affordable healthcare is an opportunity Florida legislators have less than three weeks to accept. With the federal government picking up 100 percent of the cost in the first three years (90 percent after that) and the potential for some 120,000 new jobs, it is a no brainer.

We’re calling our legislators to urge action now. Anyone who cares about the health of our community should do the same.

Martha Baker, RN, is president of SEIU Local 1991.

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