It started as a routine office visit. But then the middle-aged woman casually related her recent history of chest pain under her breastbone, occurring with exertion and associated with shortness of breath. She had diabetes, high blood pressure, and multiple other risk factors for heart disease. I shifted to high alert, worried that she was having cardiac symptoms.
Expressing my concern calmly but emphatically, I explained that I was scheduling a cardiac stress test as soon as possible.
Can we put it off until next month when I have more money? she asked immediately.
Her situation, and too many like hers, make the case for why North Carolina should agree to the Medicaid expansion offered by the Affordable Care Act. The N.C. Department of Insurance projects that almost 500,000 low-income North Carolinians will gain health insurance coverage if the state accepts it.
Medicaid has been shown to save lives and improve health. A recent study published in the New England Journal of Medicine compared three states that expanded their adult Medicaid programs with three that did not. Those with expansions had a decrease in death rates. Based on their figures, North Carolina could expect to save 2,700 lives per year.
Not as dramatic, but also critically important, are other associated benefits. Reputable Medicaid studies show that people are less likely to delay needed care if they have coverage. Additionally, many newly covered individuals report improvements in their health.
These may be dry study findings to you, but they come alive to me in my practice where I daily see patients defer needed care, avoid scheduling visits and/or skimp on medications because of the expense. I recently saw a woman who, while uninsured, had not been in for years, though she had conscientiously been bringing her Medicaid-covered children for their appointments. Think she should have exercised more personal responsibility? Tell that to her landlord or the utility companies whose bills she was trying to pay.
This situation not only takes a toll on physical health, but creates deep stress. Its no wonder that, in an Oregon comparison of people who received Medicaid with those who did not, those who did had significantly less depression.
Another positive for Medicaid expansion is that it will financially benefit our state and our medical institutions. The federal government will pay 100 percent of the expansion costs for three years, then a gradually decreasing percentage which will still be robust at 90 percent in 2020. Hospitals and doctors will be reimbursed for patients who gain coverage. Keep in mind that currently uncovered low-income people eventually get care in the most inefficient way: in emergency rooms and hospitals, foregoing primary care that could prevent disease and costing billions of dollars in uncompensated care.
Dr. Victor Dzau, president and CEO of the University Health System and chancellor for Health Affairs at Duke, makes a compelling case for Medicaid expansion:
The states cost between 2014 and 2019 would be $830 million, while the federal government would provide more than $15 billion.
That is money that will help people remain healthy, productive and contributing to the economy. It will also save money long term, enabling many more of our citizens to access care through the front door of our health care system, instead of being limited to the episodic, fragmented and expensive care that results when the emergency room the back door to the system is their only option.
With a Medicaid expansion, I will look forward to the day when my patient can focus on her heart and not her empty wallet.
Gov. Pat McCrory and legislature, do the right thing! Support the Medicaid expansion for our citizens physical, mental and financial health.