Expand or be Damned

From the time the first bill presented to Congress by President Barack Obama for Affordable Healthcare was released for public perusal, I have been reading and researching on it. Not as a constant of course, but as questions come up, I refer back to it and give the correct answers to these questions as not only my passion but also as part of my job. That being said, I have been very aware and very disgusted by the misinformation out there about the law.

I have yet to address Medicaid Expansion in this blog because I do work in the field and could not afford to lose my job over a comment that could possibly be taken the wrong way. However, I am proceeding with caution, as I think it’s time I did speak up. Georgia needs Medicaid Expansion. Hospitals are folding without the funding Medicaid Expansion would provide.

The biggest arguments against Medicaid Expansion are monetary related. They involve reimbursement rates and the cost of the program. The fact is, we’re already paying into the program; we’re just not getting any of the benefits. It would not cost Georgia any more than we’re already paying to accept the expansion package. So we have to ask ourselves, who is gaining what by not participating in Medicaid Expansion? Because millions of us are losing by not taking it; not just the uninsured, but those who lost their jobs when facilities closed and those who have to go a lot further to seek healthcare as a result of those closings.

I’ve heard the argument that Medicaid has a low reimbursement rate. I understand the concerns on this subject. However, due to the EMTALA laws, any person who presents to the Emergency Department of any hospital must be seen and treated by federal law, regardless of ability to pay or whether or not they have insurance. (This law was signed by Saint Ronnie of Reagan- https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/ ) If the patient does not have the means to pay, the hospital absorbs the cost of their treatment which results in prices going up for everyone else. (you’ve seen people get upset that illegal aliens get free healthcare….so does everyone else that doesn’t have insurance and you’ve already been paying for it for years) This is part of the reason for closures of rural hospitals, because they’re not meeting operating costs. Sure, Medicaid only reimburses at between 40% and 50% of costs, but it’s better than 0%, wouldn’t you say? And consider that those costs are inflated by uninsured patients….if they were insured, those costs could come down and the percentage would go up. The bills created by uninsured people don’t just go away when they’re ‘written off’; they are recouped by inflation of healthcare costs. And those costs go up across the board. One facility sees another facility get more for a test they’re doing or for a supply they’re using, their prices go up too. Why did you think the cost of an aspirin in the ER is about what you’d pay in a grocery store for a whole bottle?

I know what you’re thinking. You’re thinking that’s just greedy doctors etc, but hospitals have overhead to meet too. They have to pay doctors, nurses and staff, but they also have to pay power bills, water bills, gas bills, phone bills, internet etc. What do they need internet for, you ask? Because when you come to a hospital for the first time, and have no medic al records on file, they can now reach out to your doctor via internet stored medical records and find out your medical history so they know how best to treat you. Is this something you’re willing to sacrifice for the sake of cost? I didn’t think so. Why do you think they ask for all your personal information? It’s not JUST for billing you.

And don’t look down on your housekeeping staff in a hospital. Their job isn’t just to wipe down and mop. They have to change your infection ridden bed sheets in the best way to avoid giving your infection to the next occupant of the room. Their own health is just as much at risk as the doctors’ nurses’ and techs’ health. And they must be paid as well, though they are often very much underappreciated. They are not there to be your servants. They are there to protect you from yourself and the infections that are possible in a hospital environment as well as everyone else. And yes, I say yourself because you can contaminate your own wounds by not properly cleaning up after yourself. Just going to the bathroom and not washing your hands and touching an open or exposed injury or wound could give you a staph infection, so many of those law suits over staph infections could very well be self-inflicted. Think on that for a while.


Without proper funding, we are opened up not only to lack of healthcare in some rural areas, but also substandard care that could lead to disaster health wise and community wise. So when supporters of Medicaid Expansion say without it, lives are at risk, they’re not just being drama queens. They aren’t pulling fear out of their hats to scare you into supporting their cause. They’re stating the facts. Infection and illness are no small matter and must be taken seriously. And yes, Medicaid expansion is solely about caring for those who are sick or helping prevent sickness or the spread of it. It’s not just a political issue; it’s a public health issue.

Private doctors have more of a reason to not want to accept Medicaid expansion plans because while hospitals have other means to provide services, doctors’ offices are more limited. However, if doctors’ offices and clinics would take Medicaid patients, costs would also go down because there’d be less people seeking treatment in the emergency room because they could obtain preventive care. Preventive care is paid at 100% of the allowed amount. Whether or not that allowed amount is 40% or 50% or what have you, its overall impact on the cost of healthcare still makes it well worth the sacrifice. If a patient seeks preventive care, more expensive care can be avoided because expensive illnesses can be caught early.

Early on in my life, I thought doctors and medical professionals were respectable simply because they cared about people. I have learned the hard way that many get in it for the money. It makes me sad that the Hippocratic Oath means so little to so many medical professionals that they would deny a human being healthcare over money. Can’t we get behind Medicaid Expansion for the greater good at least?

And you can’t convince me it doesn’t work. It’s working in the many states that accepted Medicaid Expansion at the onset of the ACA. The only thing standing in the way is politicians and their lobbyists. Go to https://www.healthcare.gov/ to read for yourself.


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