Letter: Legislators need to reconsider Medicaid expansion
Please ask Delegate Hodges and Senator Norment to reconsider their positions on Medicaid expansion. They are opposed to any expansion, and that opposition is costing Virginia $5 million every day.
I’ve been a doctor in emergency medicine for 25 years. Nights, weekends, holidays. Seeing all who come for help. This is not only our mission in emergency medicine, it is federal law. The law, EMTALA—the Emergency Medical Treatment and Active Labor Act—states that emergency departments have to provide a medical screening exam and stabilizing treatment to anyone who comes to us for help. The law was written so that those with no insurance, or with no copay, can get the help they need for a stroke, heart attack, or injury. But how do they get care for preventive care, for health maintenance?
In the emergency department, we provide care to everyone, to the insured and the uninsured and the underinsured. We take care of their emergencies. We admit them to the hospital if that is what they need, and we transfer them to a higher level of care if that is what they need. If they don’t need to be admitted, we send them out for follow up. The insured go back to their primary care doctors, or to specialists, if that’s appropriate. The uninsured and underinsured, who have no access to primary care doctors, specialists, and no access to appropriate medications, where do they go?
A few make it into the free clinic system. But for most, they have no access to care, because they don’t have insurance. According to Virginia state guidelines, they are too rich for Medicaid (an insurance program between the federal government and the state, run by the state, to help the poor and disabled). But, they are too poor to pay for insurance on their own. We take care of them for years, sometimes decades, off and on in the emergency department, and keep score while their health deteriorates. They have very manageable conditions such as hypertension and diabetes that go untreated, resulting in heart failure, renal failure and strokes—all of this suffering that is preventable, if they only had access to care. And then, when their health is ruined and they are disabled from heart failure, or on dialysis, then we pay for their care. Only then do they get Medicaid.
ACA—the Affordable Care Act or Obamacare—raised some taxes and moved other tax dollars out of certain programs, such as Disproportionate Share payments to hospitals, in order to pay for Medicaid expansion in the states. The Supreme Court said that this was constitutional. The Supreme Court also said that states didn’t have to expand Medicaid if they didn’t want to. These federal taxes were to pay for states to expand their Medicaid coverage of the poor, to make it so that those who could not afford insurance could get it. In fact today, right now, the federal government has budgeted to give Virginia back $5 million a day in federal taxes that we have paid, that will help pay for insurance to provide care and alleviate suffering. Five million dollars every single day that Virginia has already paid in taxes that they are ready to give us back, our legislature is not willing to accept. Why?
We doctors and hospitals will survive, we will figure out our business plans, cut jobs and limit services if we have to, and we will continue to shift costs to those who are insured, continue to rob Peter to pay for Paul’s free care. But what of the poor, the uninsured? What about their suffering? Is this the best we can do for the least of our brethren?
Please ask your representative in Richmond to end the political tug-of-war. Please ask them to help their constituents get the care that we can provide.
James Dudley, M.D.