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My view: Medicaid expansion will significantly save money for Utahns

Tom Metcalf

Published: Sunday, Nov. 11 2012 12:00 a.m. MST

In this Thursday, June 28, 2012 file photo, Rep. Tim Murphy, R-Pa., center, holds up a copy of the Supreme Court's health care ruling during a news conference by the GOP Doctors Caucus on Capitol Hill in Washington. Republicans in at least three states want to abandon an expansion of Medicaid in President Barack Obama's health care overhaul, and more than a dozen other states are considering it in the wake of the June 28, 2012 Supreme Court decision removing the threat of federal penalties. The states considering whether to withdraw from the expansion include presidential battlegrounds Florida, Ohio, Pennsylvania and Colorado.

Associated Press

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Recently I testified before the Social Services Appropriations Subcommittee of our Legislature, a subcommittee which will have direct input to the decision made by Gov. Gary Herbert and the Legislature on whether to accept or reject the Medicaid expansion for Utah under the Affordable Care Act, Obamacare.

The Supreme Court left it to the states to choose to expand Medicaid, or not. In Utah the expansion would provide health insurance for tens of thousands of Utahns who do not have it now.

I gave the committee the view from pediatric practice: Over the past years, I have received many phone calls from moms with sick children and with no insurance. The vast majority were not deadbeat moms — I knew them — they were usually moms and dads with two or three kids, often both parents working in small business or they are self-employed and unable to afford insurance. What are they supposed to do when their child is sick or injured?

Sometimes I'd see them in the office and not charge, but I'm in business, just like the insurance companies, and I couldn't afford to do that very often. Sometimes I'd see the child and charge the parents, knowing they couldn't pay my bill. Sometimes they'd wait until the kid was a lot sicker, and go to Primary Children's emergency room and be charged a much higher price.

Often I'd hear from the ER about a child they'd seen — the parents had been too embarrassed to call me and had gone straight to the ER. This isn't the way to provide economical health care.

An acute sick visit, say for an ear infection, costs $85 in my office and $688 in Primary's ER.

An extended office visit for an acute asthma attack, with albuterol treatments, is $118 in my office and $745 in the ER.

A Well Child Check in my office, which could prevent the asthma attack in the first place, is $112. An unpaid bill from the ER damages a family's credit rating, forces the hospital to foot the bill and costs all of us.

We all pay for that child's care, and at premium levels. Contrast this with a child's visit paid for by Medicaid after the expansion — I could see the child in my office, be reimbursed at a reasonable rate, and with a much lower administrative cost to taxpayers than with private insurance.

I have a very concrete view of one function of government, as being responsible for providing some services for people who otherwise couldn't afford them, typically through no fault of their own — fire and police services, public education for the many who can't afford private schools, disaster relief, and health care.

The federal government, using our tax money to spread the burden, would send a very large sum of money each year to Utah in the Medicaid expansion, to extend health care to those very moms and dads who can't afford to provide health care for themselves or their children. Herbert and the Legislature have only to say yes and provide a relatively small additional amount, much less than the cost to the public were these people to remain uncovered.

The Medicaid expansion would provide significant savings to Utah Medicaid by having children and adults seen in a timely way, in an appropriate setting, instead of in the expensive ER.

I ask that the governor and legislators to accept the Medicaid wxpansion.

Tom Metcalf is a retired pediatrician who continues to work actively as an advocate for children, and other people, too.

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