There are Republicans in Missouri who argue that the nearly 800,000 people in this state without health insurance already have access to the health care system.
They are not entirely wrong. Anyone who can get to a hospital emergency room can be seen by a doctor. If you have no means to pay, your care might even be free.
But somebody always pays.
This is the side of the equation that the opponents of the Patient Protection and Affordable Care Act often ignore. Before “Obamacare” became the law of the land, those without health insurance often got a free ride paid for by those who have it. That caused overall health care costs to increase. Worse, emergency care is much more inefficient than preventative care, so it’s an exponential problem.
Paying for indigent care has been the hidden tax nobody liked to talk about. It’s part of the reason for inflated costs of nearly every element of the health care system.
The long-term philosophy behind the ACA is that everybody should have access to the most efficient sort of health care, thus more fairly spreading out the costs. For those states that have agreed to expand Medicaid coverage to people making up to 138 percent of the poverty line — states like New York and Colorado and California and Oregon and Illinois — the promise of cost-control and improved access is already coming true.
Not so in Missouri.
Missouri’s failure will cause huge cost problems and contribute to hundreds of premature deaths. The problems last week crashed into ConnectCare, a St. Louis nonprofit provider that provides outpatient specialty medical services to the poor. The Post-Dispatch’s Jim Doyle reported last Wednesday that ConnectCare is laying off 88 employees.
Let’s let ConnectCare president and chief executive Melody Eskridge connect the dots:
“Without Medicaid expansion, money to serve the uninsured and underinsured was going to dry up,” she said.
Missouri lawmakers were told in no uncertain terms this would happen. The health care system is changing, with the new model being to insure everybody, and reduce federal payments to cover the indigent. With insurance, poor people will have access to better care, less expensive care. In the end, with expansion, the system is fairer and more predictable.
Without it, Missouri loses jobs while other states expand their health care industry at our expense.
“This is the day the rhetoric becomes reality,” Robert Freund, executive director of the St. Louis Regional Health Commission, told Mr. Doyle. “Without Medicaid expansion, we will start losing capacity in our medical institutions, particularly in those that serve our most vulnerable populations.”
By expanding Medicaid, Missouri lawmakers not only would have provided the working poor with better access to health care, they would have created a jobs program and pumped money into the state’s moribund economy.
Instead they played right-wing political games, hoping to make the implementation of Obamacare more difficult.
Those 88 people losing their jobs at ConnectCare will be followed by hundreds, if not thousands, of others. And then there’s the not-so-minor issue of where poor people get the care that emergency rooms don’t provide.
ConnectCare was created in 1997 to provide the sort of services once provided by the city’s public hospitals. ConnectCare helped provide uninsured people with chronic illnesses the care that not only kept them alive, but kept them out of St. Louis-area emergency rooms. That saved those hospital systems money. That lowered the costs passed along to insured patients, and the businesses paying for their health care.
Now those costs are going to rise. Many of the uninsured won’t have access to the subsidized federal health care because Missouri lawmakers don’t want them to have it. They’ll have no choice but emergency rooms. Costs will rise. Care will be less efficient.
Some of them will simply forget about life-saving surgery. Some people will simply die.
This is the reality facing the Missouri Legislature. It’s the reality that was presented to interim legislative committees at cities all over Missouri this summer, by literally hundreds of health care experts, patients and business leaders, who begged lawmakers to accept the federal dollars which will pay entirely for the first three years of Medicaid expansion.
Real jobs and real lives are on the line while too many Missouri Republicans think they can simply wish Obamacare away.
Doctors take an oath that tells them to first, “do no harm.” The tragedy is that Missouri lawmakers didn’t take the same oath.