Medicaid expansion should go forward

Print Friendly and PDF By: Jacqueline Fincher Published: Dec 12, 2012
Dr. Jacqueline Fincher

Dr. Jacqueline Fincher

Last week, I sent a report documenting the many benefits of accepting federal dollars to expand Medicaid to Gov. Nathan Deal from the Georgia chapter of the American College of Physicians (ACP). We represent 2,676 internal medicine physician specialists and medical students.

I spoke for our patients when I asked Gov. Deal in a letter to do the right thing and accept this unprecedented opportunity to provide coverage to our poorest patients.

The five-page report I sent is called “How Will the Medicaid Expansion Benefit Georgia?” It explains why it is in the best interests of residents, physicians, hospitals and the state itself to adopt the expansion. It notes that extending Medicaid coverage will reduce the number of uninsured Georgians, most of them from working families, by as much as 42 percent.

States now have the option of expanding their Medicaid programs to all individuals with incomes up to 138 percent of the federal poverty level, which in 2012 is equal to $14,856 for an individual or $30,656 for a family of four.

The federal government will cover 100 percent of the cost of the expansion for the first three years. States will gradually assume a portion of the cost, topping out at only 10 percent of expenses starting in 2020, while the federal government will finance more than 90 percent of the expansion’s cost. Currently the federal government covers about 67 percent of Georgia’s Medicaid expenses.

The Georgia chapter of ACP believes that it is imperative that our state accept the unique opportunity that is now available to use federal dollars to expand Medicaid to the working poor and near-poor in our state.

I have many patients in my rural Thomson practice whose very lives may depend on whether Medicaid is expanded.

I think of “Mrs. Ellie,” who is now 60 years old and provides full-time care to her mentally disabled husband of 40 years, her 85-year-old mother, and a couple of grandchildren during the day.

Mrs. Ellie has not had health insurance in more than 15 years. She has multiple chronic medical problems, including high blood pressure, high cholesterol, thyroid disease, gout and anemia, and is on eight daily medications to control them. She and her husband live on his monthly Social Security disability check.

When you live below the federal poverty level and have no insurance, every dollar is already being spent on food and housing. Sometimes Mrs. Ellie can get her medications and sometimes she can’t. But if she ends up in the emergency room or requires hospitalization for want of a $10 or $20 dollar medicine, we will all pay thousands of dollars to care for her, especially the local hospital and the doctor.

I also think of “Mr. Jim.” He’s a 43-year-old married man with four children. He had a good job at a manufacturing plant here with good health insurance until two years ago, when he was laid off. His wife, who had also been working full time, was laid off a year ago.

They both found temporary jobs, working full time but at almost half the salary and no benefits. Unfortunately, Mr. Jim has insulin-dependent diabetes, high blood pressure, high cholesterol and chronic kidney disease, and has started having chest pain. He can’t afford the stress test and cardiology evaluation. My prayer is that he doesn’t have a heart attack before we can get him the help he needs.

Both of these patients would qualify for Medicaid under the expansion. These are my patients who are hardworking citizens of our state. If these patients, who are heads of households, can’t get the medical care they need and either become disabled or die, their families will then become our collective responsibility to support through the state welfare programs and nursing homes.

Some 22 percent of Georgians — nearly 2 million people — were uninsured between 2009 and 2010, according to the Kaiser Family Foundation. It is estimated that 843,000 Georgians will be eligible for Medicaid coverage, including 648,000 newly eligible recipients, under the new health reform requirements.

No matter where one stands on the Affordable Care Act itself, the evidence is clear: Georgia will benefit by accepting federal dollars to extend Medicaid, and will be harmed if it does not.

Other major findings in the report include:

* Medicaid expansion to Georgia’s low-income uninsured will improve health status, reduce preventable deaths, and enhance the quality of life.

* Medicaid expansion will help the “safety net” of physicians, hospitals and academic medical centers better serve their low-income patients and reduce cost-shifting.

* Medicaid expansion will benefit the state fiscally, with the federal government paying almost all of the costs of extending the program to more Georgians.

* Accepting federal funding to expand Medicaid will reduce the amount of uncompensated care provided by physicians and hospitals — costs that are shifted to everyone else in Georgia in the form of higher premiums and taxes.

If Georgia turns down or delays accepting this unprecedented offer of federal money to extend Medicaid, we will be leaving our poorest citizens with no other way to get coverage. The result will be poorer health outcomes for our citizens, more uncompensated care for physicians and hospitals that take care of them, more cost-shifting for the rest of us, and ultimately, higher costs to the state’s taxpayers.

Jacqueline Fincher, M.D., MACP, is the managing partner of McDuffie Medical Associates, a private practice of internal medicine in Thomson, and is the governor of the Georgia chapter of the American College of Physicians.

 

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