Beyond all the complexities about health policy, there’s one question I’d like to ask anyone who opposes Medicaid expansion or isn’t sure how she’ll vote.
Since America doesn’t have universal coverage, some people have jobs but don’t have health insurance and can’t afford to buy it. Why not expand Medicaid for people like that?
Let’s break this down. Unlike other industrialized countries, we have a hodgepodge of insurance where not every person is covered in some way.
The result is that Americans have no guaranteed coverage. According to the U.S. Census Bureau, 49 percent of Americans have coverage through an employer, 19 percent through Medicaid, 14 percent through Medicare, 2 percent from other public programs (such as care for veterans), and 7 percent through the individual insurance market. Nine percent of Americans are uninsured.
Absent an employer mandate or a much higher wage or universal coverage, some low-income working people won’t have health coverage. They’ll earn a wage but the job doesn’t offer coverage or they won’t make enough to buy it.
This will happen even though health insurance is important if you get sick and for detecting illnesses early.
Having coverage also protects from huge medical bills. Six months ago, my husband was in the hospital with a pulmonary embolism. He’s often said that because the symptoms were subtle, he might not have gone in for treatment if he didn’t get coverage and the doctors say if he hadn’t, he’d be dead. If he didn’t have coverage and had sought care, he’d have well over $50,000 in medical bills now.
Expansion foes sometimes suggest that we should make it easier to buy cheap insurance that won’t cover much of anything, making it pretty worthless when it’s needed.
Big bills come from getting into an accident. A slip on an icy sidewalk or road could break a leg and require at least one surgery. Others huge costs can come from a serious illness that runs in your family or comes out of nowhere. Some pay a lot because they have chronic conditions that need expensive monitoring and medicine.
Still, some people might say a working person who doesn’t have coverage and can’t afford it should be on his own. While I don’t agree with that, for reasons that include the impacts on public health, the effects on everyone’s medical bills, and my ethical system, that would be an honest response based in the reality that we don’t all agree about what government should do.
But a lot of the arguments being made against Maine’s Medicaid expansion referendum instead involve stigmatizing or dishonesty or both.
The organization most involved in opposing Question 2, the referendum that would expand Medicaid, calls itself Welfare to Work, using a stigmatized term that falsely implies the people who would gain coverage under expansion aren’t working.
In fact, people in the Medicaid gap make too much to qualify for subsidies to buy insurance under the Affordable Care Act.
This odd situation is not because the drafters of the law didn’t think about these people. They were supposed to be covered by Medicaid expansion but the Supreme Court let states decide whether to do so and over 60 percent of states have chosen expansion.
Some expansion opponents say people should get charity care but that wouldn’t pay for prescription drugs. It’s a non-solution that would undermine the finances of local hospitals, many of which are struggling in rural Maine.
Expansion opponent state Sen. Eric Brakey falsely claimed that the Maine Legislature rejected expansion five times. In reality, the Legislature passed it five times but it was vetoed by Gov. Paul LePage each time.
Rather consistently, expansion foes claim that the last time Maine expanded Medicaid it didn’t matter much. But in truth Maine managed to increase coverage a bit while the rest of the country saw a big surge in people without coverage.
They also deny the consistent research findings that, compared to those in states that didn’t expand Medicaid, people in Medicaid expansion states got more preventive care and have better finances and stronger self-reported health. Hospitals also do better.
Meanwhile, they have no real answer for the waitress or the hairdresser or the carpenter’s helper or the vet tech who doesn’t have health coverage because they can’t afford it and it’s not available through their job.
Mainers’ answer should be delivered through voting yes on Question 2.