After the Supreme Court decision on the Affordable Care Act, states are faced with a decision on whether to expand Medicaid eligibility. Utah remains undecided. In the last story in our series, The Future of Medicaid in Utah, we look at how the decision affects all of us as taxpayers and healthcare consumers.
Charles Pruitt is a pediatric emergency medicine physician in Salt Lake City. He’s seen his share of tragedies in the ER, but one little girl still haunts him - not just because she died under his care, but because he believes her death was preventable. She came in complaining of headaches – headaches so bad she couldn’t sleep. He asked her mother how long it had been going on. The mother told him several months.
“I did a CAT scan of the girls head, and found what I really feared the most, which was a large brain tumor, a very large brain tumor,” Pruitt said.
Pruitt had to tell the mother and girl that the tumor was inoperable, and the girl was going to die.
“In the back of my mind I kept thinking, why did she have to wait so long? I started to feel like I had failed her, and like we - as a medical community - had failed this little girl and her mother. And then my frustration turned more to anger,” said Pruitt.
The family did not have insurance, and the mother - a single parent – told him that, even working two jobs, she could not afford to take her daughter to a primary care doctor.
“I was left with the feeling that this was so preventable, this tragedy,” said Pruitt. “Had the family, the little girl and her mother, had the options that every child should have - just the ability to go and have your symptoms checked out when they occur - that this wouldn’t have happened. This little girl would still be alive today.”
Pruitt says he’s seen more uninsured showing up in the ER since the recession. He’s in favor of expanding Medicaid in Utah, not only because it would increase access to healthcare, but because he says it would bring down the costs for those who already have insurance. It’s Pruitt’s contention that we all pay for the uninsured in the form of higher premiums. So, he says, we can pay now by funding an expansion of Medicaid or pay later as healthcare costs continue to grow.
“We would all be better off if this little girl had had access to healthcare, and overall the costs of medical care would be a little bit less,” said Pruitt.
On the other side of the spectrum is Stan Rasmussen of the Sutherland Institute, a conservative think tank in Utah.
“Only in the United States is death considered an option,” said Rasmussen, “We have allowed healthcare to get to a point, where if people get sick and actually die, that the assumption is made that somebody fouled up, and things have unfolded that shouldn’t happen.”
It’s Rasmussen’s position that government is overly involved in healthcare, and that an expansion of Medicaid is a move in the wrong direction.
“We believe that the expansion would make more Utahns dependent on a government program that’s already becoming unaffordable,” said Rasmussen, “Lawmakers should stand up and refuse to sell Utahns self-reliance and independence for a few dollars.”
State lawmakers are now weighing the arguments. Currently the federal government pays for 70 percent of Utah’s Medicaid funding. Under the Affordable Care Act, the federal government would foot 100 percent of the funding for Utah’s Medicaid expansion for the first three years, gradually decreasing to 90 percent by 2020. Representative James Dunnigan is Chair of the state’s Health System Reform Task Force. He says even with substantial federal contributions, he’s concerned about how much money Medicaid will eventually cost the state.
“We need to decide… do we want to do it, can we afford to do it? Even though the federal government picks up 100 percent over the first several years, our share increases, and we’re talking a lot of dollars.”
The state Department of Health has estimated that if Utah expands Medicaid eligibility up to 133 percent of the poverty level, it would cost the state 239 million dollars over the next 10 years. It would cost the federal government more than 3.5 billion. Those figures don’t take into account those already eligible for Medicaid who are expected to enroll when the individual mandate goes into effect. Utah would be responsible for paying for 30 percent of those costs – which would amount to more than 900 million dollars in the next decade. Senator Stuart Adams is on the Task Force, and he says the growth of Medicaid is unsustainable.
“Nobody’s figured out how to pay for it,” said Adams, “If we have to borrow, or we have to print money, or some other unsustainable way, someone is not being realistic with the promises or the commitment they’re making to the public.”
But even with these concerns, Utah’s Governor and lawmakers aren’t saying no outright to a Medicaid expansion. Norman Thurston is the state’s Health Reform Implementation Coordinator. He says the US Department of Health and Human Services still hasn’t provided some important information that may inform Utah’s decision.
“There is a big question that’s unanswered in my mind, and I think a lot of states have now brought this up, which is… what alternatives do we really have? Because it looks on paper like it’s black and white -you either have the expansion or you don’t - but we’re pretty sure that’s not the end of the story,” Thurston said at a meeting of the state’s Health System Reform Task Force.
Thurston wants to know if there is room for a partial expansion, waivers, or block grants. HHS officials would not tell KUER whether the federal government will negotiate on this point. Without this information, Thurston says it’s too soon to make a decision.
The Department of Health estimates that more than 50,000 additional people could enroll in Medicaid if the state expands eligibility. If the state chooses not to expand, it’s not clear what option these people will have for health insurance, or whose responsibility it would be to help them… if anyone.