Before you read this column, take a moment to glance down. If you’re like the vast majority of Mainers, you will see your two feet.
A very few of us — people who had a serious illness, birth defect, accident or war injury that led to them having one foot or none — won’t see these appendages.
That second group once included my late father-in-law Bert, a veteran and small businessman who lost a foot after late-stage diabetes imperiled his circulation. Bert ate well and walked regularly, often taking a stroll when his football team was blowing a game. He watched his blood sugar and took his insulin. All of that was not enough.
To give as many Maine people as possible the chance to keep their feet through their lifetimes, we must make the right policy decisions.
As a recent article in the medical journal Disability and Rehabilitation explained, “fateful delays of care” were common among people who had amputations that could have been prevented. Those delays are far more common for people who don’t have health insurance. When a problem starts, they can’t afford care, so they wait. A foot gets worse and it ends up amputated. This is more costly and consequential.
Many other medical problems arise from lack of health insurance.
Dr. Joe Feinglass, one of the study’s authors and a professor at Northwestern University’s medical school, wrote in the BDN that, “Over 40 years of research has documented that the uninsured have fewer doctor visits and fail to receive basic preventive services like blood pressure screening, pap tests, cholesterol testing and influenza vaccinations. As a result, the uninsured are diagnosed at more advanced stages of cancer, especially for cancers detectable by screening. The uninsured are much more likely to have undiagnosed high blood pressure and high cholesterol, more severe strokes and poorer control of diabetes.”
When the Maine Legislature took up Medicaid expansion, lawmakers passed it five times. But five times, enough Republicans supported Gov. Paul LePage’s veto so it couldn’t be overridden.
During that time, Republican leaders sometimes claimed that health coverage didn’t help reduce preventable illnesses and deaths. That was incorrect. Moreover, if they truly believed that, why do they have heath coverage for themselves and families?
Other times, they suggested it was rude to mention a New England Journal of Medicine study that found “176 additional adults would have to be covered by Medicaid to prevent one death per year.” But there is a clear relationship between coverage and care that prevents deaths and serious illnesses.
There were some who said that Maine’s level of insurance didn’t increase when we earlier expanded MaineCare. Left out was that states that didn’t increase coverage saw the percentage of uninsured soar, while Maine’s insurance rate did not.
Another argument by opponents of Medicaid expansion was that it wouldn’t help hospitals’ finances. Not only did the Maine Hospital Association disagree, but a slew of reports from bond ratings agencies show that hospitals in states where Medicaid was expanded are in much better financial shape than those where expansion was rejected. That’s because the number of uninsured fell so much in the first group.
LePage was so opposed to expanding Medicaid that he spent no time trying to find a creative approach he might negotiate with the federal government. Instead, he put all his chips on Gary Alexander, an incompetent analyst and plagiarist.
According to Census data, Maine was one of two states that saw its uninsured population rise in 2013.
Meanwhile, other Republican governors, in states as varied as Utah and Pennsylvania, have worked out novel Medicaid policies so many thousands in their states will get care.
Why? The ideology that motivates LePage holds that public health insurance injures recipients’ ability to thrive. This was voiced recently by pundit Ray Richardson in a column for the Portland Daily Sun, who said that programs for the working poor, many not healthy, “enslave” them “to the new plantation.” According to Rep. Amy Volk, R-Scarborough, those are “more dangerous than allowing them to fend for themselves.”
Care is dangerous? In reality, without coverage, working lives are cut short and people are more likely to suffer serious consequences, from strokes to limb amputation. Mainers are hurt, not helped, by suffering what could have been prevented.
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