Is It Time to Close the Medicaid Gap?

The first sign of trouble was not particularly dramatic, but it got my attention. Last November, when the Supreme Court was hearing cases in Twin Falls, I felt a pain in my left side just as we started hearing our second case. It felt like a heavy pressure was being exerted below my rib cage. I thought it might be a heart problem, which prompted a visit to a doc-in-the-box. The doctor assured me it was not a heart issue but could not pinpoint the cause of the pain. I left with an antibiotic prescription, but the pain went away before I could take one.

In early December, when the Court was hearing cases in Boise, I had a recurrence of the pain. I visited my family doctor, who ordered an MRI to see if it might be an ulcer. When the result came back, it looked like there was some sort of mass on my pancreas, so I went in for a CT scan to further investigate. The scan disclosed a tumor on the pancreas, so I went in for an endoscopic ultrasound. The ultrasound probe goes down into the stomach and sidles right up close to the pancreas to get some really good pictures. Biopsy samples disclosed that the tumor was malignant. Since then it has been surgically removed and I am currently on chemotherapy.

All of the medical folks have said it was good the cancer was caught early. We all know that early detection of almost any illness is important to a favorable patient outcome. Luckily, I had good insurance coverage under the State’s plan–the same plan that protects the health of Idaho legislators and executive branch employees. Without the three relatively expensive exploratory scans paid for by the insurance company, I would have been out of luck.

I think of the 78,000 Idahoans in the Medicaid gap and wonder about their fate when they start having suspicious symptoms. I suspect they just have to suck it up and take a pain reliever. No costly tests for them to find the cause of puzzling symptoms. Most of these folks work hard to take care of their families but make too much to get Medicaid coverage and too little to get subsidies under the Affordable Care Act (ACA). Had Idaho opted to take the many millions of dollars available to expand its Medicaid program, like 31 other states have done, those people could have a chance for a good outcome.

It seems to me that the time has come for Idaho to join the other 31 states and get some of the life sustaining funds that we have previously allowed to go to other states. It is not clear whether the Affordable Care Act will be amended, repealed or remain in place. But, based on what has occurred in the debate thus far this year, it does not appear that Congress will repeal the Medicaid expansion that was part of the ACA. Idaho should now demand its share of the Medicaid expansion money. Continued refusal to take the money will perpetuate the unattended medical problems suffered by Medicaid gap families. This is a moral issue, not a political issue. We should not require that people dispose of their assets to qualify for Medicaid or, worse, that they run for public office in order to get good health insurance.

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