Johnson City Press Saturday, October 25, 2014
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Medicaid expansion benefits everyone in the community

April 7th, 2014 9:18 am by Judy Garland

Medicaid expansion benefits everyone in the community

A criticism of my support for Medicaid expansion appeared in a letter to Forum a few months ago. The writer wondered if I were aware of two recent studies from Oregon and the University of Virginia, which he touted as evidence that Medicaid isn’t a program worth expanding or even continuing.
Neither study should be summarized with one sentence each. The Oregon study received national attention because it seemed to indicate new Medicaid enrollees, after two years, were still using the emergency room for primary care, which the Affordable Care Act was supposed to discourage. Intelligent evaluation concluded that’s likely temporary and more a matter of educating insecure people on their options. For conservatives, though, it’s a sure failing of Obamacare.
What seemed to interest my critic was that both the Oregon and University of Virginia studies supposedly found that Medicaid patients often fared worse than the insured and, gasp, even the uninsured. The Oregon report does not bear out the claim about health outcomes.
The authors of the University of Virginia study would prefer their report no longer be used as evidence against Medicaid expansion. It’s a flawed study, and they have had the good grace to admit it. Politifact.com has the author’s full five-paragraph piece outing the weaknesses of their own work.
One major concession, for instance, was that their report on the high rate of in-hospital deaths of Medicaid patients, compared to the insured and the uninsured, didn’t take into account the co-morbidity health issues of the Medicaid patients when they were admitted, like already metastasized cancers and advanced diabetes (not unusual in people who haven’t had preventive care).
The comparison between Medicaid patient in-hospital survivability and that of the uninsured demonstrates nothing but a misunderstanding of the two categories.
Medicaid patients are the very poorest, usually without adequate support systems. The uninsured, as often as not, are people of means who either don’t choose to buy insurance or who are denied access by insurance companies and, as often as not, are people who regularly see doctors for preventive care and who have good support networks.
To suggest the uninsured are somehow more disadvantaged than Medicaid patients is illegitimate and misleading.
According to Tennessee hospital spokespeople, the state will receive $38 for every $1 we spend on expanded TennCare, money that will flow into local economies and state coffers in Nashville.
Anyone concerned about cuts to “education, law enforcement, infrastructure, food inspection, school lunches or unemployment benefits” as a result of Medicaid expansion should be far more worried about those and other services if we don’t expand Medicaid. Our medical job losses and hospital closures will be massive and the ripple effect will not be pleasant, to put it mildly.
We have a skewed understanding of Medicaid, generally. Sixty percent of Medicaid funds go to nursing homes for elderly people who’ve exhausted their resources for long-term care.
My critic is nostalgic for that time “not too long ago when people took care of their own.” I’m not sure exactly when that was, but I do know Social Security, Medicare, Medicaid, food stamps, unemployment insurance, Pell grants and other safety net programs came about precisely because we weren’t taking care of our own — nor, in all probability, could we have done so. The stress and personal cost just of health care would have been overwhelming even if we’d been good at it.
The best way to relate to that is to make it personal. Would our work or church communities, charitable organizations, families and neighborhoods be enough if they represented the only support we could count on should our own health fail? It’s way easy to let that be the lot of the nameless and faceless poor. Let it be personal in a beloved elderly family member whose need for Medicaid in a long-term care facility is imminent — $60,000 a year is the norm in those facilities.
Rural Area Medical clinics set up for free care in our area once or twice a year, and hundreds wait in line, often 10 hours or more, to see a doctor or a dentist. One man described walking 15 miles to reach the clinic. RAM used to set up clinics worldwide, before realizing the desperation of our own people. Is that third-world country setting really a commentary on our region with which we’re comfortable? People’s lives are at stake. This shouldn’t be a political football.
“Bureaucrat” may have become a pejorative, but that’s unfortunate. People who administer Medicaid and other public services are more likely to be compassionate, sort-of-decently paid public servants with difficult, often heartbreaking jobs to do. I, for one, am happy to contribute to their livelihoods and to the vital programs they administer. It’s by far the most efficient, cost-effective way to meet the needs of the least fortunate among us.
The more my country and we in communities recognize our mutual responsibility to each other, the prouder I am.

Judy Garland of Johnson City
is a community activist.

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