The most important numbers regarding Medicaid expansion (Guest column by Allen Perkins)

Mobile Press Register, by Allen Perkins, M.D. on May 28, 2013

A lot of numbers are getting thrown around regarding the optional Medicaid expansion that is found in Obamacare. Expanding Medicaid would bring $1.2 billion in federal money directly into Alabama, some of it going to pay for the care of those who are currently uninsured. That would mean even more money for Alabama's economy because of the multiplier effect. Some 12,000 jobs will be created.

But it will mean even more to our economy than that.

Imagine you are the mayor of a small town in Alabama. The last 5 years have been difficult, what with the loss of the plant down the road and such. It finally looks like things are looking up. You have gotten several phone calls from Acme Auto Parts Manufacturing, looking into the industrial site being advertised. The questions they are asking though are not about the rail access or tax incentives. They want to know how good the schools are and what the healthcare is like. The problem is, they have access to the internet and have been looking at the Kaiser Family Foundation website.

Acme asks about the health of the potential employees. Your county is like every other county in Alabama. High unemployment has meant 1 in 5 of the people in your town who are employable (ages 18-64) have not been insured and have not had access to care except through the emergency room. You think of Mary, who had a stroke because she couldn't afford to get her blood pressure medications refilled in town and couldn't afford the drive to Birmingham to go to the "free clinic." You think of Joe who had chest pains that the doctor swore was his heart and packed him in the ambulance for a trip to Birmingham, a heart catheterization, and what turned out to be an expensive case of indigestion. Joe's health insurance was through his wife's job, but she got laid off two years ago, so he had no coverage for the "life-saving" cardiac intervention. Joe still owes $100,000 to the hospital and his shop is still closed. You cross your fingers and say everything is fine.

Acme asks you about the hospital. You sit on the hospital's board and know that it's having a hard time making ends meet. Many of the uninsured people in town use the emergency department as a clinic of last resort. They often wait until they are very sick, ending up being hospitalized for things that, if treated earlier, would never require an emergency department visit, much less a hospitalization that will never be paid for. Both emergency department visits and hospitalizations are above the national average in Alabama. The hospital is currently getting (not enough, but some) money from the federal government for taking care of the uninsured. At the last board meeting you heard that Obamacare was moving that money into expanded Medicaid coverage. You cross your toes and say everything is fine.

Now Acme asks you about the Medicaid expansion. They know that Alabama has up to 500,000 people who will be covered under Medicaid if the state elects to expand. They also know that if the expansion doesn't happen, they will be hiring people who have had delayed health care, increasing the cost of training and keeping new employees due to more days lost from work. They know that being members of the community, they will be paying for care of uninsured people through higher costs, either at the hospital or through higher local taxes. They know that having a lot of uninsured people in the county will chase doctors away, forcing employees to take a day off to go into Birmingham for care. You regretfully say you don't think the governor sees the expansion as a possibility at this time.

They offer their thanks for your time and promise to get back with you. Next time you hear about Acme Auto Parts Manufacturing, it's a story about their new plant in Kentucky, where Governor Beshear accepted the Medicaid expansion.

The number that is important is "one."

One uninsured small businessman who delays expensive care is no longer able to keep his business open. One worker who ignores her high blood pressure is no longer able to work. One hospital overwhelmed with uninsured is no longer able to keep the door open. One town without available healthcare cannot recruit jobs and dies.

Taking advantage of the expansion allows us to end this story very differently. Which ending do we want?

Dr. Perkins is Professor and Chair of Family Medicine at the University of South Alabama College of Medicine in Mobile. The opinions he expresses are his own.

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