Last week, Mississippi Governor and potential presidential candidate Haley Barbour (R) — who vigorously opposes expanding the state’s Medicaid program — tried to minimize his state’s health care access crisis by arguing, “There’s nobody in Mississippi who does not have access to health care.” Barbour maintained that hospitals and doctors routinely provide charitable care and said that residents without reliable access to health insurance received care from clinics.

Barbour may be technically correct — the 1986 Emergency Medical Treatment and Active Labor Act requires hospitals to treat emergency conditions — but as Aaron Carroll and Austin Frakt of the Incidental Economist point out, the emergency room is not a good place for patients with chronic conditions:

Over 25 million people in the United States have diabetes, requiring regular access to medication to stay alive. They can’t get insulin in an emergency room. They can’t get needed eye exams or kidney function tests in the emergency room. They can’t get a checkup in the emergency room. But once they go into hypoglycemic shock or once their feet become gangrenous, then they can get examined and treated. Does that sound like access to health care?

About 20 million people in the United States have asthma. They can’t get their prescription refills in an emergency room. They can’t get the equipment then need, like nebulizers or inhalers or spacers in an emergency room. They also can’t get checkups in an emergency room. Once they have an attack so bad that they could die they can get examined and treated, but that’s not access to health care.

Over 200,000 women were diagnosed with breast cancer in 2010. Not a single one of them could get a mammogram in an emergency room. Over 140,000 people were diagnosed with colorectal cancer in 2010. Not a single one of them could get a colonoscopy in the emergency room.

Nearly one in 100 children have Autism, and not a single one of them can get any treatment at all in the emergency room. More than 5 million children have attention deficit hyperactivity disorder (ADHD), and not a single one of them can get any treatment at all in the emergency room. Around ten percent of all children may qualify for interventions for developmental delay, but few get them, and not a single one of them get them from an emergency department.

Americans often think of health care as acute care — you have a condition that requires emergency surgery, so you go into one of the country’s state-of-the-art health centers and undergo the needed procedure. Most of health care is far more simple. It’s not about complex surgery or fancy technology: it’s about keeping patients healthy, managing their chronic conditions so they don’t worsen, and preventing them from needing that surgery in the first place.

You can’t find that kind of care in an emergency room, particularly when the availability of good emergency room care is in decline. In 2006, 119 million visits were made to ERs, up from 90 million in 1996. At the same time, the number of hospital ERs dropped to fewer than 4,600, from nearly 4,900, causing wait times to also increase.

The Boston Globe’s Christopher Rowland looks at why Mississippi Governor and potential presidential candidate Haley Barbour (R) is so vigorously opposed to expanding the state’s Medicaid program, which could result in “new Medicaid benefits flowing to 300,000 to 400,000 Mississippi residents.” In a phone interview with the paper, Barbour made it clear that he doesn’t believe that the state — which has an 18 percent uninsurance rate, 28 percent poverty rate and suffers from very high instances of obesity and chronic diseases — is experiencing a health access problem. Residents just need to eat better and exercise, he maintains:

“There’s nobody in Mississippi who does not have access to health care.” … Hospitals and doctors in the state routinely provide charitable care, he said. Residents also can get care from clinics such as the one by the side of Route 49 in Yazoo City, as well as larger and better-equipped community clinics scattered around the state. And Barbour pointed to his efforts in the Mississippi Legislature, unsuccessful so far, to win passage of a voluntary insurance exchange where small businesses and individuals could shop for insurance at discount rates. [...]

“Most of the health disparities in Mississippi are not because of the inability to get access or afford health care,’’ said Barbour. “They are because of diet, alcohol, because of drugs, the very high incidence of illegitimacy that leads to high incidence of low-birth weight children.

“I grew up in a society where if it wasn’t fried you were asking, ‘Why not?’ If it was good you would make it even better with a lot of sugar and butter on it.’’

He added that substance-abuse prevention and encouraging healthier diets do not require a massive expansion of Medicaid.

An ounce of prevention is worth a pound of cure, but expanding access to coverage would actually improve access to preventive services and help tackle the high instances of chronic conditions in the states. In fact, the health law actually provides enhanced Federal Medicaid matching funds to States that offer evidence-based prevention services.

What baffles providers in the state is why Barbour is turning down a deal under which the federal government — because of the expansion to Medicaid under the Affordable Care Act — “will pick up 100 percent of the cost of the Medicaid expansion from 2014 to 2016 and 90 percent of the cost after 2020.” It’s true that the state will have to spend extra dollars to cover the expanded population, but those services are worth paying for in a state where many people “earn too much to qualify for Medicaid but not nearly enough to purchase private insurance” and go without needed medical care. Barbour estimates that the state’s share of expanding the Medicaid eligibility umbrella, “while starting at zero, could climb to as much as $237 million a year by 2020 — when the state would have to start picking up 10 percent of the cost.” That’s a good investment — a tiny share of the total price tag — and well worth it for the benefit of expanding access to care for hundreds of thousands of residents and reducing the heavy costs of uncompensated care that hospitals and doctors now have to provide.

In fact, it’s far more sensible than the current system in which every resident of Mississippi has access to care in the emergency room. Barbour is right on that point, but he can’t possibly think that having uninsured individuals flock to the emergency room for something that could have been handled in a primary care setting or addressed through preventive care is a smart or efficient use of taxpayer dollars.