The human costs of refusing to expand Medicaid | Arkansas Blog

Wednesday, April 9, 2014

The human costs of refusing to expand Medicaid

Posted By on Wed, Apr 9, 2014 at 11:08 AM

click to enlarge COVERAGE GAP: Charlene Dill had a documented heart condition, but when Florida refused to expand Medicaid, she was left without health insurance. Last month, Dill collapsed and died. - CREDIT: GOFUNDME.COM
  • CREDIT: gofundme.com
  • COVERAGE GAP: Charlene Dill had a documented heart condition, but when Florida refused to expand Medicaid, she was left without health insurance. Last month, Dill collapsed and died.

Great story from the Orlando Weekly
 on Charlene Dill, a 32-year-old mother of three working three part-time jobs who died because of a documented heart condition. Dill fell into the "coverage gap" in Florida: She made a little too much to qualify for the state's existing Medicaid program but too little to qualify for subsidies on the newly formed health insurance exchange. When the state refused to expand Medicaid, that left a gap in coverage for low-income residents, and left Dill without options for health insurance.

Dill’s death was not unpredictable, nor was it unpreventable. She had a documented heart condition for which she took medication. But she also happened to be one of the people who fall within the gap created by the 2012 U.S. Supreme Court ruling that allowed states to opt out of Medicaid expansion, which was a key part of the Affordable Care Act’s intention to make health care available to everyone. In the ensuing two years, 23 states have refused to expand Medicaid, including Florida, which rejected $51 billion from the federal government over the period of a decade to overhaul its Medicaid program to include people like Dill and Woolrich – people who work, but do not make enough money to qualify for the Affordable Care Act’s subsidies. They, like many, are victims of a political war – one that puts the lives and health of up to 17,000 U.S. residents and 2,000 Floridians annually in jeopardy, all in the name of rebelling against President Barack Obama’s health care plan. ...

These are the people in the coverage gap – the unknowns, the single mothers, the not-quite-retired – the unnamed 750,000 Floridians who are suffering while legislators in Tallahassee refuse to address the issue in this year’s legislative session, which ends on May 2. The working poor – who used to be the middle class – are on a crash course with disaster for no logical reason. Charlene Dill, at the age of 32, didn’t have to die.

ThinkProgress goes for the dramatic headline: "This 32-Year-Old Florida Woman Is Dead Because Her State Refused To Expand Medicaid." I can't really endorse that — the medical experience of any one individual is too specific and too complicated for a narrative that neat. Still, the story is a reminder of the human beings left in a coverage gap by the states (still 23 of them) refusing the federal money to expand their Medicaid programs and offer insurance for low-income residents. (Here's more on Dill from an emotional blog post by a close friend.) 

This is once again an opportunity to give thanks that enough Arkansas legislators were willing to put ideological rigidity to the side and come up with a way forward for the state to offer a safety net for its neediest citizens. The Orlando Weekly story notes a study projecting that 2,000 Floridians annually may die because of the state's decision on Medicaid expansion. In Arkansas, meanwhile, a Rand study found that if the state had said to expansion, it could have led to more than 1,000 deaths otherwise avoidable with increased healthcare coverage.

These sorts of studies offering an estimated death count are inevitably controversial, and some skepticism about a projection like that is in order. But the underlying question facing the 23 states holding out against Medicaid expansion is simple. It's the same question that the Arkansas legislature will face when it has to decide whether or not to re-authorize the private option next year. As we've said before, it is a political question and a moral question. It is a question about priorities.

Will we commit to ensuring that our neediest citizens have access to health coverage or not? People like Charlene Dill. 

Or, in Arkansas, people like Melissa Farrell and Charles Lott and Claudia Reynolds-LeBlanc and Rick Wells

People like Wendy Phillips, from Searcy. People like Jennifer Trader, from Springdale. People like Sherri Thomas, from Walnut Ridge. People like Hope Smith, from Jonesboro. 

People like Ellen Louise Fant

People like Anita Geiger and Amber Chote

"Nobody here wants to hurt anybody," Rep. Bob Ballinger, one of the strongest opponents of the private option, said during this year's debate over re-authorization. Rep. John Hutchison, who voted against re-authorizing the private option this year, said he didn't want to leave people "in the cold" and without insurance. But that's precisely what would have happened if the legislature had defunded the private option. It's precisely what happened to Charlene Dill in Florida. 


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