EDITORIAL: Should Utah Expand Medicaid or Rely On Charity Care?

Senior woman

Since the passage of the Patient Protection and Affordable Care Act (Obamacare) more than three years ago, Utah has known that it has a choice to make: participate in the Medicaid expansion or not. That decision has been delayed until now, but the time has now come for the choice to be made.

130,000 Utahns are living just above the federal poverty level, which currently disqualifies them from receiving Medicaid health coverage and leaves them unable to obtain basic healthcare or medications. Under the ACA, states choosing to expand Medicaid coverage to those people would see 100 percent of the costs of doing so covered by the federal government for three years. After the three years federal dollars would taper off slightly in the next decade, but even at its lowest point Utah would only be responsible for 10 percent of the costs.

Arguments over whether to participate in the program have been flying, but until this week it was mostly unknown how implementing the program would actually effect the Beehive State financially or economically. In a moment of clarity several months ago, Utah’s Republican leaders chose not to guess on what the impact would be, and appropriated a large amount of our tax dollars to an independent research company who were tasked with completing an in-depth analysis of what the true costs of the Medicaid expansion would be. That report came back this week.

According to the report, if the expansion were implemented the state would save an estimated $20 million in the first three years alone, and $131 million overall from no longer having to subsidize unpaid hospital bills and emergency room bills. The expansion would also produce 3,552 new jobs, generate $286 million in additional state economic activity, and contribute over $20 million in state and local revenue by year 2022. Hospitals and medical facilities  who are currently spending an estimated $331 annually on uncompensated care would also see significant savings from this under-served population obtaining health insurance.

There has always been a moral argument for participating in the expansion. These 130,000 Utahns who live just above the federal poverty line are our brothers and sisters, neighbors and friends, and (for elected officials) constituents. An individual making $1200 per month does not have the option or the luxury of paying $500 per month for private health insurance. Yet illnesses happen, injuries happen, and basic medical needs will always arise. Allowing these individuals and families to obtain Medicaid health coverage is not only morally right, but ethically necessary.

Yet, there are some in Utah’s government who are ignoring their own commissioned report which says the expansion is the economically and fiscally sound thing to do. Instead, they are encouraging Utahns to rely on so-called “charity care” to solve the problem. Charity care refers to a doctor or other medical provider giving away their services for free. During the 2013 legislative session, Representative Michael Kennedy (Republican, Alpine), himself a doctor, touted charity care as a viable alternative solution to providing access to healthcare to these low income citizens, saying he regularly donates his services to people who need it.

While we applaud Representative Kennedy for his apparent goodwill, there is no viable alternative or policy that could turn charity care into a reality for 130,000 people in the state. If Charity care were viable, it would have already solved the problem. Obviously it hasn’t, which means that for it to work the state legislature would need to enact a law requiring medical providers to donate their services to low income families. Even if we ignore the logistical nightmare of medical providers now having to obtain the financial software and systems necessary to determine their patients’ incomes, such a law would be tantamount to indentured servitude. In addition, there is already a growing physician shortage in the United States, and the Association of American Medical Colleges estimates that by the year 2025, America will be short 125,000 physicians. In other words, there is already a burden on our medical providers, and for Utah’s government to push them to work for free is almost laughable.

It was understandable when Utah’s elected officials wanted to delay making a decision on Medicaid expansion until all the facts were known. Even though there is a clear and strong moral reason to expand, it is fair enough to say we should wait until the numbers come back. But now we have the report the legislature and governor commissioned, and it says, without any mincing of words, that expanding Medicaid is sound fiscal policy, and will actually save the state millions of dollars, save hospitals millions of dollars, and create more than 3,500 new jobs for Utahns.

Utah needs to expand Medicaid. It’s the moral, ethical, and economic thing to do. Elected officials who still preach against it run the risk of being seen as putting partisan politics ahead of the desperate needs of those who elected them into office in the first place.

The due diligence has been done. Your move.

2 Replies to “EDITORIAL: Should Utah Expand Medicaid or Rely On Charity Care?

  1. Why should any state be so ignorant as to cut off its own nose to spite its face? People are dying and suffering. If the money is rejected by selfish and ignorant political purposes, then these political piles of waste should be swept into the septic tank of history. The poor ignorant individual represented by these assinine politicians should be educated by those who are intelligent enough to care. This won’t be easy. I live in a small (teeny-weeny) town that is so red that it blinds me. My brother told me that I am probably the only progressive democratic in town. I’m not particularly smart, and it took me a while to understand what is really going on, but the problem haunts me every day. I am a seventy year old female who moved here nearly eight years ago. Because I am not a Mormon, or a Baptist, or a Republican, I have nowhere to go. I moved here to be close to my brother and sister. I sit here alone every day because my sister has stopped speaking to me over political differences and my brother just doesn’t get it. There is not much hope for me in Utah. I would go back to California, but I am stuck here. I am a Veteran, but the VA facilities are too far away and I can’t afford the gasoline to travel the distance. I need health care, and dental care, but where do I go to get it unless there is some affordable alternative? Utah needs to get with the program, even though it is flawed in its present form, it is much better than nothing.

  2. The choice to not accept the expansion is the dumbest thing i have ever heard. The only reason a political representative would vote against this is that they don’t care simply because they don’t deal,with it. I used to have great insurance, but had to change jobs, when i did this there is a waiting period for the health insurance, unfortunately, I became very ill before this time was up and lost that job.
    Now first of all I will say even if I had Health insurance at that time, I would have lost it anyways due to the time that this illness has lasted. Now some who make good money may argue well you could have gotten Cobra, Let me make one thing clear I tried that route once Cobra is the biggest joke as an option for anyone, the cost is double what you were paying before and without that income how are we expected to pay it, that program only works if someone goes directly to another job. and even then usually that high cost is not feasible.
    Now for someone in my shoes, due to my wife’s income we were just barely over the limit income wise, to qualify for medicaid, unless we did a spin-down, LOL what a joke that is, my spin down was $2000 a month, If i could pay that i could buy better insurance than ever before.
    So, that left me no insurance for over a year. And for 6 months of that time with no medical care for me. Luckily i finally was able to get the Hospital to pay the bill on my testing and procedures and Regular doctor visits at the hospital only. It only paid for some things but not all.
    This made things very frustrating in trying to find a diagnoses and to receive proper treatment and medicine. It delayed many results and options, leaving me waiting long periods of time for medication. Now I finally have been approved after almost 2 yrs for medicaid due to disabilities and income loss. Finally i have been able to receive help, but here I am again, Medicaid refuses to pay for certain things, No dental for adults instead people like myself have infections now due to that, they will not pay for some of the tests needed to help to find diagnoses to my illness.
    I have been told now i need specialized treatment from a place such as the Mayo clinic, this also is not covered and not like I could afford a place to stay while there. I have lost everything to this illness, my life, my car, my home, and my family. It upsets me to here that the state would play with so many lives and place them in a position like mine, to lose everything and end up on state assistance, housing, and lose their lives they had just because the state cant see how it would be a big deal.
    Ass for Representative Kennedy, I applaud you offering your time and services to people for free, But charity services from doctors are very few and hard to find, on top of this they are usually very limited on many things. And to add the majority are through someone religion, which i myself have been turned away for not being a part of their religion. So though you may offer this service and i will personally thank you for doing this because you are one of the few, you are only contributing a small single digit contribution to the very large number needed.
    To the original post let me say this, They say 130,000 Utahan’s are in this situation, that is the number estimated by the amount that they get reports on or and is an estimate, in fact that number is higher due to the fact that some people would be impossible to count if never known of. Just like he higher number of people not working , or below poverty.
    The poverty level in this country set by the government is a joke, maybe in the early 1950’s this would be the poverty level but i can say that that level is a joke people making above minimum wage now can’t even afford a place for themselves let alone a family to live in.
    Let me tell you I was in the middle class making good money and it barely paid the bills, and it was not because i lived beyond my means the middle class in this country is rapidly becoming the poverty class and no one is paying attention or they are denying it. Open your eye people, there are more people in this country loosing homes, jobs, and lives due to this and it needs to be taken very seriously. As for anything coming from the government right now.
    Most of it is lies or BS that it will help, but the medicaid expansion, is one step that is necessary and morally right.
    Get it done and quit arguing like little kids, You should be working together to find solutions not fighting over small things that really don’t matter except for political gain if you are only hear for your political gain, you should be fired, for not representing all of your people.

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