April 11, 2011
mental health aca affordable care act access sympsoium obamacare narrow networks reference pricing contraceptive exchange health reform health insurance exchanges marketplace fqhc safety net decision making patient engagement electronic health records cms electronic medical records health care cost medicaid michigan small business oregon depression readmissions aco health care costs costs medicare health policy exchanges politics wellness programs rules election courts coverage dual-eligible funding cheboygan memorial communication scotus employers poverty variation cost use quality research policy health insurance acos hmos essential benefits reform sgr congress drugs class long term care va e-prescribing emrs patient safety states for-profit nonprofit block grant tanf welfare reform hospice end of life non-profit evidence-based care waste washtenaw county uninsured population health managed care cancer end-of-life care individual mandate ryan proposal obesity pharmaceutical industry r & d comparative effectiveness research evidence based care quality improvement collaborative quality initiatives cqi pharmaceuticals regulations prematurity heath reform antibiotics overuse geographic variation medical appropriateness health websites imrt radiation therapy medical errors constitutionality translate health care economics rationing insurance regulation incentives cardiology pcmh health disparities british health care system guidelines radiology pain early childhood physician employment dartmouth atlas cover michigan health care coverage insurance preventive care public health
I met a young man last week who lost his job in December of 2009, and despite his best efforts, still hasn’t found another. He told me he had excellent health benefits through his previous employer, but rarely needed to use them. He described himself as a typical young and healthy patient – going in for routine cleanings at the dentist’s office and seeing a primary care physician for nothing worse than a bad cold. Given this, losing his health insurance was not at the top of his worry list when he lost his job.
That is, not until he became sick and had to be transported to the emergency department in an ambulance.
Without insurance, although his ambulance ride lasted just 15 minutes and his visit with the attending physician less than 20, his medical debt from that one incident will last many years.
This young man is just one of the over 1.2 million people in Michigan – over 50 million in the U.S. – who lack health coverage. Hearing his story reminded me that those big numbers are more than statistics describing a population. Those numbers are made up of individuals – people we know, work with, our own families, even - whose health and financial security is at risk every day they are uninsured.
And thousands have lost their jobs during the economic downturn, which usually means losing access to health care coverage. Many thousands more work in low-wage jobs with no benefits and can’t afford to purchase health coverage. And too many times, even when people are employed and have coverage, medical expenses have driven families into bankruptcy.
The young man I talked to last week said he is now trying desperately to find some type of coverage so he can follow up with a physician and get the drugs he needs to manage his condition. Even though he has little or no income, as an able-bodied male with no dependent children he does not currently qualify for Medicaid.
In her April 19, 2010 blog post, Marianne Udow-Phillips describes the history of the Medicaid program, originally intended to cover certain categories of low-income people: mainly children, pregnant women, people with disabilities, and those over age 65 living in nursing homes. Because of this “categorical” eligibility, being poor alone does not qualify one for Medicaid, leaving many low-income individuals out of this public insurance program. And outside of Medicaid and other smaller state-based and local public programs, there aren’t many other options for low-income individuals to get consistent and affordable care.
In 2014, the Affordable Care Act will change this picture for the first time in U.S. history by eliminating categorical eligibility and expanding Medicaid eligibility to all non-elderly citizens and resident immigrants who are below 139 percent of poverty. In Michigan, 686,600 uninsured individuals under the age of 65 meet this income standard today. The Medicaid expansion will open up coverage for millions in the U.S. who have limited or no access today.
With millions of individuals potentially entering Medicaid rolls in 2014, states and communities should be planning now to support these individuals and connect them with the health care system. Federal, state and local communities must also address how to fund the Medicaid program and allocate resources so that the influx of new patients will have access to medical care, not just an insurance card. A loss of a job in the U.S. should never again mean loss of health.
It is my hope that in fifty years, when the history books, blogs, and articles are written about health care and health reform in the U.S., stories like the one I heard last week will be just that. Stories from the past.