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Medicaid could keep even more people healthy if Florida agreed to expand it

I remember sitting in the hospital admissions office in 1963. I was 10. When the clerk told my mother the daily charge, I panicked. My mom said, “Don’t worry, we have insurance.”

I’d never heard the word before, but it imprinted on me as something families must have to protect against financial ruin.

While in the hospital, I met a boy who’d been burned over much of his body. I remember our short friendship; we were two miserable kids passing the time in the pediatric ward. Along with physical pain, he had emotional stress. His family was poor; they did not have this thing called “insurance.” One day, he jumped out of the window.

Two years later, Medicaid passed. The boy would have had insurance.

July 30 is Medicaid’s birthday, and all Americans should celebrate. Medicaid now covers two in five children in Florida and four in seven disabled Floridians needing nursing-home care. Medicaid is not perfect, but it is a huge help to millions of people.

Like all of the insurance programs cobbled together in our country’s healthcare system, including private insurance, the Affordable Care Act — or Obamacare — marketplace plans and Medicare, there is ample room for improvement. But 54 years after its birth, there’s overwhelming evidence that Medicaid saves lives and improves health outcomes. There also is undisputed evidence that it does so at a lower cost than any other insurance program.

Moreover, the Medicaid Act’s initial failure to cover low-income uninsured adults was finally fixed in 2010 with the passage of the ACA. In a monumental step toward health justice, the ACA eliminated the cruel fiction that only certain ages and “categories” of people deserve insurance.

This progress was cause for nationwide celebration. But, tragically, after the Supreme Court ruled in 2012 that Medicaid expansion would be left up to individual states to decide, Florida and 13 other states have refused federal dollars to provide Medicaid to low-income uninsured adults.

That means that, in Florida, along with celebration and gratitude for Medicaid, there’s tremendous regret and an urgent need for action. While Florida’s Senate has twice passed Medicaid expansion bills, the state House of Representatives has blocked it. Worse, this year they passed into law a measure that will make it even harder to achieve Medicaid expansion through a ballot initiative. When voters are given a chance to decide, expansion has been approved — even in conservative states such as Idaho, Utah and Nebraska. Most Americans intrinsically understand that illness and injury can strike anyone at any time and believe that healthcare is a human right, regardless of age or status.

As a legal services health lawyer, I’ve seen how uninsured people suffer. Like the boy I met 56 years ago, I’ll never forget one of my clients, a hotel maid who had a breast lump. Her doctor ordered a biopsy. But she had no insurance and could not pay the required deposit. Weeks went by as we advocated for a change in the hospital admission policy. Then months went by; then the tumor broke through her skin.

I’m even more conscious of the injustice in rejecting Medicaid expansion after a recent diagnosis of breast cancer. But because I have insurance, I go for checkups, and my tumor was found early. I had a timely biopsy. I’ll be fine. Hard-working uninsured Floridians like my client with the tumor have a much less optimistic prognosis.

Indeed, last week the National Bureau of Economic Research released a working paper analyzing “annual excessive deaths” in states that have not expanded Medicaid. Florida has had 694 a year since 2014. In other words between 2014 and 2017, 2,776 Floridians died because the state had not expanded Medicaid. In addition, the authors estimate there will be a growth rate in deaths over time.

This injustice can, and must, be fixed. All seats in the Florida House of Representatives are up for election every two years, and in 2020 we can reject those candidates who have rejected Medicaid expansion.

Miriam Harmatz is executive director of the Florida Health Justice Project, Inc.


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