Dr. Sara Ghori Tariq, an internist and medical director of the Center for Clinical Skills at the University of Arkansas for Medical Sciences (and named by her peers as a "Best Doctor"), described her encounter with an uninsured patient she saw as a volunteer physician at Harmony Health Clinic.
"I saw a gentleman a couple of weeks ago with a large abscess in his leg, a pocket of infection. ... It was extremely painful," Tariq said. He was employed as a dishwasher and couldn't afford insurance, so he'd waited to seek medical attention. His diabetes was a contributing factor, but he couldn't "consistently afford" insulin. He needed treatment, blood sugar tests and antibiotics. Had his blood sugar been too high, Tariq would have needed to send him to the UAMS Emergency Room for care.
Patients who don't have insurance "tend to be absolutely more sick, more challenging" to treat, Tariq said. They put off doctor visits to avoid the cost of paying out of pocket. The man with chest pain, the woman with a lump in her breast — had they come to the doctor at the first sign of trouble, they would have been better outcomes, both physically and financially. The effect of poverty, low health literacy, the lack of social support and homelessness on patient health is one of the things Tariq addresses in her clinical skills classes at UAMS.
If Tariq's patient (and others) had access to Medicaid, he wouldn't have had trouble paying for the medicine he needed, thus avoiding the complications from his disease as well as lost wages. UAMS could have been spared the cost of treating him in its ER. Taxpayers would have paid less, with contributions to Medicaid on the front end alleviating the need for emergency care.
Doctors at UAMS treat all comers, insured and uninsured; 12 percent of its admitted patients — 3,120 last year — are among the latter. Outpatient visits by the uninsured numbered 61,426 in 2012. Charity and unreimbursed care rose from $175 million in 2011 to $202 million in 2012. Those numbers would be less if Arkansas, which has the most stringent rules for Medicaid eligibility in the country, would agree to accept federal dollars to expand Medicaid — now limited largely to children, the disabled and impoverished pregnant women — to a wider group of Arkansans too poor to pay for private insurance. Two plans are under consideration: extending Medicaid to all Arkansans at or under 138 percent of the federal poverty level ($11,490 for individuals, $23,550 for a family of four) or a deal Gov. Beebe and the federal Health and Human Services Department worked out to extend the private insurance exchange option to that same group of people at no cost, with premiums picked up by Medicaid. (The Affordable Care Act allows tax credits to certain persons earning between 138 percent and 400 percent of the poverty level tax credits to pay for private premiums on the insurance exchange. Arkansas is the only state so far to be offered exchange coverage for persons whose income puts them under 138 percent.)
Tariq said she hoped the legislature would act to expand access to health care quickly.
It's been noted that putting off acting on Medicaid expansion by a year — something the legislature is, as of this writing, considering — would mean the state would sacrifice one of the three years in which expansion will cost it no money (2014, 2015 and 2016 are the years the federal government would pick up the tab; after that, states will contribute 10 percent). But the monetary loss is not the main concern of Dr. Joe Thompson, director of the Arkansas Center for Health Improvement.
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