Careful studies have long indicated North Carolina’s rejection of Medicaid expansion is extraordinarily costly. Not only does the state forgo tens of billions of federal health care dollars, hundreds of millions of state and local dollars in tax revenue, tens of thousands of jobs, hundreds of millions in savings for uncompensated hospital care, but, more directly, 463,000 low-income Tar Heels are denied health care coverage intended under expansion.
Huge numbers of poor residents are now effectively barred from routine medications for treatable conditions. They will not receive tests and screenings that maintain health. As many as 1,145 deaths a year will occur prematurely and thousands more will suffer, triggering soaring, disproportionate medical costs for emergency procedures.
Still, the data don’t reflect the tragedy fully. So the NC Poverty Fund released a study with interviews of North Carolinians in the Medicaid gap and the doctors who try to serve them. The stories are wrenching and anger-invoking in the world’s wealthiest nation.
Dr. Steve Luking, a Reidsville family practice physician, says: “For more than 30 years, I have watched my patients with no insurance pay a terrible price. I’ve seen women die of invasive breast cancer and cervical cancer when they couldn’t afford mammograms and preventative checkups. I’ve hospitalized patients who stopped their medicines so they could pay other bills....Despite what people say, the emergency room doesn’t provide the care these folks need. When was the last time someone received a pap smear or a screening colonoscopy in an emergency room?”
The most wrenching lesson for Dr. Pradeep Arumugham, a Kinston heart specialist, came last year when a patient, who made about $10,000 yearlyworking at a diner, faced severe danger of heart failure. Arumugham treated her initially in the Lenoir Memorial’s emergency room. He stabilized her, but her heart was weak. She was in her early 60s. Her sister had died from the same malady.
She needed a defibrillator but couldn’t pay for it. She couldn’t afford insurance on the open market. She couldn’t qualify for subsidies under the ACA because, ironically, she was too poor. Arumugham saw her for several months but was unable to get a defibrillator. So she died. “She would be alive today if we accepted Medicaid expansion. That’s the simple fact,” he said.
Dr. Julius Mallette, Kinston Community Health Center chief medical officer, says: “A lot of patients can’t meet our sliding scale, though it is low. And many more can’t pay for the specialist referrals their illnesses require.”
For many patients, “if we can’t get them on Medicaid, we can’t fully treat them,” he said. Sometimes that means a subsequent, crushing emergency room bill. Often, it’s from the mortuary.
Dr. Evan Ashkin serves low income patients in Caswell County, though the UNC system. He grimaces when politicians say “we won’t allow rationing in our health care system.” What we have now, he says, is “rationing by wallet biopsy, the worst possible basis to allocate health care.”
Ashkin explains: “I believe health care is a human right. I also think that on a purely economic basis the argument to extend Medicaid is unassailable. Locally, regionally, statewide. Ideology is overcoming rational, common sense decision-making. And it is taking a hideous toll on some of the most vulnerable people in North Carolina.”
As Martin Luther King wrote, “of all forms of inequality, injustice in health care is the most shocking and inhumane.”
Gene Nichol is a Boyd Tinsley distinguished professor at UNC-Chapel Hill.