I am a pediatrician. Last week a patient's father asked me to listen to his heart because his chest hurt and he didn't have insurance. This is not good medicine. I also saw two girls without insurance. Their mom works three jobs to pay for food and shelter, so she earns too much for Medicaid. Ridiculously, if she worked less, the family would qualify for Medicaid. Is this really the message we want to send? Currently, young adults without kids cannot get Medicaid, even when severely ill. One way people can qualify for Medicaid is to have children, because poor families with children can qualify. So we are encouraging those without means to have kids so they can get health insurance? Lastly, if someone without money becomes disabled they qualify for Medicaid. Again, what message are we sending? This does not encourage or foster independence from public assistance.
We live in the wealthiest country in the world. We have the best health care in the world. Yet, one person out of six in this country cannot go to the doctor because they lack health insurance. We are the best. We have the most. But not really. Many people still go without.
We can do better. Federal health care reform can help. Part of the Affordable Care Act is the expansion of the state Medicaid program. Expanding Medicaid in our state would give nearly 200,000 more people health insurance. This includes poor working adults and families. Now Medicaid covers poor children, pregnant mothers, families with young children and people with disabilities. Adults without children cannot receive Medicaid.
The federal government will pay for this expansion for the next two years. After that, they will pay 90 percent of the cost. All of this expansion will not cost Utah anything. Independent study shows that we will at least break even, and more people can get the care they need. Utah covers the cost of medical care for inmates in jail who go to the hospital; if we expand Medicaid, 90 percent of that cost would be covered by the federal government. We also pay for mental health services and substance abuse rehabilitation at a county level; these expenses would be covered as well. Savings in these areas will help to cover the cost of this expansion.
We already cover the cost of medical care for those without insurance; however, we do it indirectly — it costs more money, and it is inefficient. Those without insurance tend to avoid the doctor. So they also avoid vital preventative care because it is out of reach financially. Currently, when the uninsured get really sick or injured, they end up in the hospital or the emergency room. Hospitals generally cannot collect large amounts from those without insurance so they have to pass those costs to paying customers through higher fees.
Some worry that the federal government will not keep its word, that they will not continue to pay their 90 percent and we will have to foot the bill. There is an easy solution. We can do what Florida and Arizona already did. We can include a fail-safe clause that says if the federal government changes the rules, we have the opportunity to re-evaluate the expansion.
Expanding Medicaid sounds like a good idea to me. The decision is up to Gov. Gary Herbert, but it is past time that we should act. Many in our community badly need this basic health coverage to be able to stay healthy or treat their illnesses.
Ellie Brownstein is a pediatrician with nearly 20 years of experience who is currently working for the University of Utah. She is also married with two children, and has lived in Salt Lake City for the last 16 years.
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