Medicaid at a crossroads

Gayathri Suresh Kumar

The U.S. House’s proposed budget plan to reduce federal support for Medicaid by converting it into a block grant program is an absurd idea.

As a physician at Grady Memorial Hospital in Atlanta, I provide care for many patients who are dependent upon Medicaid for their well-being. Without Medicaid, what would happen to my patients? Would they stop coming to their appointments or picking up their medications, knowing they no longer could afford health care? What if their medical conditions spiraled out of control and they finally had to seek help? At that stage, it might be too late for me to provide meaningful care.

As I think about all the patients who could be impacted by the House’s proposal, I am reminded of one of my patients – a man who was recently diagnosed with obstructive sleep apnea, a condition that results in momentary pauses in breathing during sleep because of brief closure of the airway. With this condition, he was constantly fatigued throughout the day, which limited his functional capacity while he worked at a nearby factory.

This patient’s income was just enough to provide for himself and his mother. But as soon as his diagnosis was established, he was fired and told that he was not fit to continue working. Without a job and a source of income, he lost health insurance coverage.

Such stories are playing out all over the country, affecting countless Americans, and it’s hard to ignore them here in Georgia. Shouldn’t we help ensure that they are the exception rather than the rule?

Without a job and health care coverage, my patient was at a loss. Without treatment, his condition could deteriorate to more severe medical complications, and possibly even death. It was just too expensive. Insurance would have helped defray those costs, but now he must scavenge for financial support, and without a job, he struggles to get by. He continues to struggle with his sleep apnea and worries about how he will support both himself and his mother. How will he ever get better without an income and health insurance? How can we expect our economy to improve if people can’t earn a living and provide for their families?

With the passage of the Affordable Care Act, I was ecstatic that by 2014, Medicaid would expand its eligibility level for adults to 133 percent of the federal poverty level, with full financial support by the federal government for the first three years. This would include coverage to many of our childless adults who were unable to gain access to Medicaid coverage if they were not disabled, elderly, or pregnant. Now, more than 600,000 Georgians would gain health insurance coverage. Finally, here was a chance for my patient to access critical health care services without fear of being denied coverage or bankrupted.

Recently, my optimism has begun to wane. If passed, the House budget plan that would repeal health reform and convert Medicaid into a block grant program would place a federal cap on Medicaid spending. With this proposed reduction in federal Medicaid spending, states would lose critical federal dollars that they rely on each year to cover low-income Americans, and our economic recovery will slow even further.

Under the House plan, Georgia is projected to lose about $1.9 billion in federal support for Medicaid. This places 38,420 jobs and $4.4 billion in business activity at risk, as Medicaid dollars are used to reimburse health care providers, medical suppliers and pharmaceutical companies. Further, given the constraints on funding, it is estimated that by 2012, Medicaid enrollment nationally will be 44 million people fewer than what is projected under the current law.

This proposal is flawed on multiple levels. Morally, we are depriving our patients of quality health care. Economically, these cuts will cost jobs for our health care providers and suppliers and slow economic recovery. Moreover, with more uninsured patients, our sick patients will continue to seek emergency room care that will lead to a rise in uncompensated care costs and an increased strain on taxpayers and society. Eventually, this may lead to cutbacks in availability of ER care, which can compromise readiness for large-scale emergencies.

This doesn’t make any sense.

Why are we spending our time contemplating methods to further deny health care access for our patients? As our politicians continue to bicker, our patients will continue to struggle for access to care, and our health care costs will continue to soar to unsustainable levels.

The Medicaid block grant program is not the answer, while the Affordable Care Act is a significant step in the right direction.

Dr. Gayathri Suresh Kumar is physician who works at Grady Memorial Hospital and currently serves as the Georgia state director for Doctors for America, a national health advocacy organization that promotes accessible, quality care for all Americans.