Expansion of Medicaid makes sense

Maine needs to expand Medicaid. Question 2 on the November ballot would expand Medicaid to more than 70,000 Mainers. It would also strengthen hospitals in this state and provide a boost to the economy. That is why groups such as the Maine Medical Association and the Maine Hospital Association have both endorsed a “yes” vote on Question 2.

According to the state’s Office of Program and Fiscal review and the Muskie School of Public Service, Medicaid expansion would bring more than $500 million a year into the state, creating 4,000 new health care jobs and helping to make sure that hospitals around the state can continue to provide care in their communities.

Expansion also helps to hold down premiums for people who buy their insurance or get it through work by reducing charity care and reducing the number of unnecessary and costly visits to the emergency room.

By the numbers, Medicaid makes sense.

Despite the claims by some opponents, expanding Medicaid doesn’t take services or care away from anyone. Just the opposite will occur. More people will access life-saving health care when they need it.

Two of my patients are good examples. I am not going to use their real names, but these stories are real.

Jim works full time. He used to have a job that gave him health benefits, but he got laid off and his current job does not offer health benefits. He works hard to help support his family, including his diabetic wife.

I never get to see Jim. I should see him — he has very high blood pressure that we have only been able to get under control by using three separate medications, but he worries about the high cost of an office visit, so he avoids coming to see me.

We have tried to select medications that are affordable, but with the difficulty in lowering his blood pressure, several of the drugs are somewhat more costly, and Jim cannot afford to pay out of pocket for them. So he goes without. He avoids checking his blood pressure because he knows it is high.

We have talked about his likely sleep apnea, which is probably keeping his blood pressure elevated, but the cost of testing and the cost of a breathing machine are well out of reach for him, so he puts that off. That puts him at risk of a heart attack or stroke, which would take him out of work and put his family in extreme financial difficulty.

Jim is one step from health disaster and financial catastrophe because of his lack of health insurance. Medicaid expansion would help him.

The second patient, who I will call Laura, also has a job, but she makes less than Jim. She also has no health insurance through her employer.

Many preventive care procedures, such as a colonoscopy, are not covered, but she can come to see me and not worry about getting a bill that she cannot afford to pay just for seeing her primary-care doctor. Lately, she has had a lot of difficulty with a tooth abscess. I have seen her several times for this, we prescribe antibiotics when it acts up, but she needs a tooth pulled, and the hospital has no dental services. She cannot afford a dentist.

There are many, many patients who come to the hospital, especially the emergency room, who are not able to pay their bill, and the hospital “absorbs” those costs.

What really happens is that the costs of that charity care are passed on to other people who buy insurance.

For hospitals that survive on razor-thin margins, patients and insurance companies paying their bills are what keeps the lights on and the doors open. Hospital cuts — positions and even full departments — are an unfortunate reality, and unpaid bills are a big reason for this. Two hospitals in Maine have even had to shutter their doors, severely impacting their communities.

For those who believe that expanding Medicaid will only help people who do not have a job, please think of Jim, think of Laura, and think of the community hospitals.

Keeping patients from having insurance severely impacts the health of people who may be employed but also live on the edge, and are just one catastrophic health event away from financial ruin.

Caring for patients who cannot pay their bills puts hospital budgets in the red, jeopardizing jobs, departments and even entire hospitals.

I urge all Maine residents to consider fellow Mainers who may be less fortunate, as well as friends and family who work in health care and the communities that these hospitals support.

Please vote “yes” on Question 2 this November.

Dr. Elizabeth Rothe is a family and sports medicine physician at Central Maine Medical Center.