The debate over Medicaid expansion has devolved into a GOP platform for grandstanding about the health reform law and the Obama administration. But an NPR article from Tuesday shines a light on what, exactly, most Republican governors’ refusal to expand Medicaid will mean for real Americans by examining poor communities in a state headed by one of Obamacare’s most ardent critics: Gov. Rick Perry (R-TX).
The piece centers on particularly destitute populations in southern Texas, where some uninsured residents are so poor, sick, and unable to cope with their medical bills that they resort to desperate measures such as crossing the border into Mexico for medications and even sharing their insulin shots:
[M]any of those who live here [in Brownsville] — including poor Latino immigrants, both legal and undocumented — suffer from diabetes and lack of insurance. Some of those uninsured diabetics, including American citizens and others living here legally, used to go across the border to Matamoros, Mexico for insulin. But now with the fear of brutal drug violence and tougher border restrictions, families share their insulin shots rather than risking the crossings.
A community health worker in Brownsville noted that “many of those who used to cross the border would qualify for Medicaid under the expansion offered by the health care law.”
This inequity is further exacerbated when dealing with a more serious or life-threatening chronic condition. One official at Brownsville’s local health clinic described how difficult it is to provide specialty care services to the poor and uninsured, emphasizing that Medicaid coverage would make it far easier to convince physicians to take on patients:
“Once you diagnose a cancer, then what?” said Dr. Henry Imperial, the clinic’s medical director. “How are you going to give me chemotherapy or surgery or radiation therapy? It goes out of our hands.”
Those complications can make for some intense arm-twisting among Brownsville’s medical ranks. Imperial said he often plies fellow doctors in town with beer to see his uninsured patients. “When they see me approaching them, they start running away,” he joked before turning somber. “It’s just tough. I could not do an appendectomy. I cannot operate on gall bladders. I need a surgeon.”
Most specialists, including surgeons, in Brownsville, accept Medicaid, said Imperial. “It does pay for services that otherwise the patient does not receive.”
GOP leaders like Perry and even some of the more serious conservative academic critics of Obamacare’s Medicaid expansion regularly cite the program’s low reimbursement rates as a reason for dismissing it. Perry has denounced expansion as doubling down on a “broken system,” since doctors won’t want anything to do with Medicaid to begin with.
But as Dr. Imperial’s story shows, actual care providers have a very different relationship with Medicaid than the picture painted in opinion columns and stump speeches. While Medicaid’s reimbursement rates are admittedly low, doctors who serve poverty-stricken communities are fully aware of — and sympathetic to — their patients’ needs and struggles. That’s why these doctors tend to accept Medicaid — and that’s why opposition to the expansion is a burden on them, too. Perry and his compatriots are essentially asking physicians to stand by their duty to treat the ill, irrespective of finances, without giving them the resources to recoup any sort of compensation for their services.
Those who actually interact with poor communities regularly understand what a life-saving program Medicaid can be. It provides a range of services and coordination with social workers that are boons to the sick and the poor — who tend to have specialized medical needs in addition to their financial difficulties — and consequently has a satisfaction rate comparable to private insurance among its beneficiaries.
Despite all that, it appears that Obamacare opponents like Perry will continue holding back reform. But the victims of this political fistfight won’t be politicians or media commentators — they will be the millions of poor Americans who must continue struggling with the unaffordable cost of their medical care.