Sen. Kurt Schaefer was asked recently on KBIA’s "Intersection" about Missourians who will remain uninsured after the legislature’s failure to expand Medicaid. He replied that in Columbia one can go to the Family Health Center and get “everything from dental care to chemotherapy there,” that uninsured people currently receive care at hospitals when needed and that “the population is generally covered, it’s a question of how you pay for it.” This reply is factually incorrect and shows a disregard for the unmet health care needs of hundreds of thousands of Missourians, including thousands in Boone County.
Family Health Center does not provide chemotherapy. And while we do have a dental center the wait to get an appointment for people without insurance is so long it is not accessible. More importantly, there are 17,000 residents of Boone County without health insurance and 14,000 in the surrounding counties. Due to our limited federal grant to provide care to the uninsured we can provide care for only a small portion of these people. Last year, we saw 3,569 uninsured patients. Statewide there are over 850,000 uninsured Missourians. There are 23 Federally Qualified Health Centers (FQHCs) such as Family Health Center in Missouri. While many uninsured people can access care at health centers and hospitals, thousands go without health care.
Furthermore, FQHCs provide primary health care. This encompasses preventative health services, treatment of acute illness and management of chronic diseases such as diabetes, hypertension and depression. Even if there were enough FQHCs to provide primary health care to all uninsured Missourians (we would need five more health centers in Boone County alone), there would still be essential medical services that health centers cannot provide: medications and medical supplies, specialty care, advanced testing, hospitalization and surgery among others.
I work with uninsured patients daily. Many have chronic illnesses such as diabetes and hypertension that are uncontrolled because they have no health insurance. They try to stretch their supply of medications by taking less than the prescribed dose. They cannot get recommended health screening tests such as a colonoscopy, and many decline medically recommended tests such as cardiac stress testing, radiology tests and other advanced diagnostic tests for fear of debt. Most personal bankruptcies in the United States result from medical bills. Many of my patients put off preventative and other health care needs because they have more immediate concerns such as food and shelter, resulting in preventable medical complications. Some patients have to be treated with stopgap measures until they can get definitive treatment. I find myself prescribing antibiotic and pain medications repeatedly to patients with recurrent dental infections who cannot get dental care and pain medications to patients with worn out knees and hips who cannot get joint replacements. My patients often cannot get physical therapy or medical equipment and supplies. I’ve had patients who after a heart attack could not get cardiac rehabilitation.
Contrary to Sen. Schaefer’s assertions, a large portion of the population is not “generally covered.” They are just going without. The moral imperative to help our neighbors should be enough to motivate us to correct this sad, unnecessary situation that results is so much sickness and suffering. If not, there are economic reasons to fix this enormous hole in our health care system. When people without health insurance get sick enough and can’t put off their health care any longer, they go to emergency rooms and hospitals where care is far more expensive. We all end up paying for this through higher health care costs. When my patient with diabetes and hypertension, who has been skimping on his health care to pay the rent, has a heart attack he will be admitted to the hospital and undergo many lifesaving (and expensive) tests and procedures. These could have been avoided if he had had health insurance. But if he becomes disabled by his heart attack then (and only then) will he qualify for Medicaid. Such is our health care system in Missouri.
The politicians who oppose Medicaid expansion and the Affordable Care Act have not offered a viable alternative to provide health care for the 850,000 uninsured Missourians. Although this issue has been studied for decades, and despite the fact that nearly all other industrialized countries provide excellent universal health care at an affordable cost, the political leaders of Missouri are forming a task force to study the issue.
ObamaCare is not perfect nor is Medicaid. But while politicians “study” the issues, people suffer needlessly. Yes, we should make improvements in Medicaid. But we should not further delay providing access to health care for every Missourian. It is morally wrong and economically short-sighted. We should tell our political representatives the time is now to expand Medicaid and provide access to health care to all of Missouri’s poorest citizens.
Andy Quint is the medical director for the Family Health Center in Columbia.