A doctor’s view of why Medicaid expansion matters

I had the opportunity to read “The other side of Medicaid expansion” by state Senate leader Phil Berger. I understand his concerns. I am trying to reconcile my perspective as a doctor who treats many uninsured patients with his argument for fiscal responsibility. This is how I see it.

Who would Medicaid expansion help?

If you are below 138% of the federal poverty level then you are eligible to get Medicaid. Federal poverty level at 138% means that if you are single and make less than $12,490 a year then you are eligible. If you are a family making less than $25,750, then the whole family is eligible. I don’t know about you, but I suspect that if these people could make more money than that, they would do so. However he may be right in that they might just be able bodied people who are sitting around doing nothing waiting for Medicaid expansion.

What does Medicaid give to a person?

These able bodied people may try to use their Medicaid card to buy cigarettes, alcohol, and god forbid steaks. Unfortunately, Medicaid does not pay for any of this. All it does is, if the patient comes to the hospital with an illness or to a physician for follow up, Medicaid will pay the hospital or physician for it. The patient gets healthcare and that is it.

Who are these able-bodied adults?

These are adults who work in small businesses, small farms, small diners, small construction jobs, etc people who you generally don’t see as uninsured. If they could be in jobs with health insurance or could afford health insurance, I suspect they would do it. In fact the term “able bodied adults” is used to make it seem like they are somehow lazy to find better work or better pay. It could be true, but I suspect it is likely not.

How much will it cost the state?

Berger estimates that it will be $173 million a year and that cost will be paid by taxing the state’s hospitals and insurance companies. I am pretty sure it’s an oversight on Mr. Berger’s part that he forgot to mention that the federal government will pay approximately $2 billion dollars a year to cover 90% of the expansion money. Being a physician my math is fuzzy, but $2 billion dollars seems a lot more money than $173 million dollars

What about crowding out disabled North Carolinians?

If we really cared about disabled North Carolinians, we probably should reform their access to Medicaid, instead using them as an excuse. One has nothing to do with the other, other than to use them for fear mongering.

What about wait times at doctors offices, delays in testing, and increasing healthcare costs?

This might be a valid concern. As of now, some of these uninsured patients do not have access to care and they sit at home and die. I agree, the cheapest patient is a dead patient and that is one way to control costs.

In my opinion, the case is very simple. Uninsured people get most of their care from the emergency department which is expensive and wasteful. Most of these people will not and cannot pay the astronomical bill. The rest of the insured people in this state pay this with increased premiums. If we had the courage to do Medicaid expansion then the state will receive the expansion money which will take care of sick North Carolinians and reduce healthcare costs for the rest of us insured people.

Medicaid is just a promise that if you get sick, we the people will take care of you. What is wrong with that?

Dr. Pradeep Arumugham is a cardiologist who serves patients in the Kinston area.