There is a bizarre health care myth that continues to make the rounds without any basis in fact. Those opposed to Medicaid expansion under the Affordable Care Act continue to make the false claim that somehow enrolling people in health coverage under Medicaid is bad for an individual’s health and it is much better to be uninsured. Just this week a member of the Utah legislature, who is also a physician and should know better, asserted that providing Medicaid health coverage to low-income people was a bad idea because: “Evidence doesn’t confirm expansion saves lives, but it does confirm expansion jeopardizes health.” His views were in line with another doctor last year that declared in the Wall Street Journal that “Medicaid Is Worse Than No Coverage at All.” And typical of think-tank commenters was this one from the Heartland Institute wondering, “whether we’d be better off replacing the [Medicaid] expansion with a program that hands out $500 in cold hard cash and a free puppy.”
This isn’t a new topic, and people like Jonathan Cohn have been debunking this canard for years. Common sense would say that being able to not worry about thousands of dollars in bills when you get seriously ill and need to see a doctor is better than trying to live without health coverage. But no need to rely on what your mother would say – a quick look at the evidence is convincing. The best survey comes from Matt Broaddus and Edwin Park at the Center on Budget and Policy Priorities who pulled together the research a couple months ago when Congressman Paul Ryan tried yet again to claim “harms” from Medicaid: “Numerous studies show that Medicaid has helped make millions of Americans healthier by improving access to preventive and primary care and by protecting against (and providing care for) serious diseases.”
In the current fact-free debate environment, sometimes a call to look at the research alone just isn’t enough however. You have to look at actual people affected by these debates and realize that a Medicaid expansion would mean an immediate and profound change in their lives. And one doesn’t have to look far to see the suffering of low-income workers without health coverage. In my former life as a state health advocate I met people all the time who were suffering with unimaginable economic hardship and pain simply because they couldn’t get care or were so far in debt for the last-ditch emergency care they had gotten. One person who affected me the most was the construction worker I met in Hickory, NC with knees so bad they felt “full of crushed glass” who couldn’t afford the thousands of dollars in surgery it would take to give him relief and so lived with his pain through every working day.
Other reluctant states that have so far refused the federal dollars for Medicaid expansion have similar stories. There’s the uninsured department store clerk in Florida who, struggling to deal with treatment for advancing breast cancer, faces choices unimaginable to most of us. Or the mother of five in Utah who, hit with her own unaffordable treatments for cervical cancer, comes home to utility shut-off notices on her front door. Or the diabetic small business owner in Texas who had to declare bankruptcy because of overwhelming medical bills.
These stories are all the harder to take because if these people lived in the majority of states that have already expanded Medicaid they would be receiving affordable health coverage. North Carolina, Utah, Texas, Florida and other states that have so far refused expansion under the Affordable Care Act could change course quickly. Medicaid expansion under the Affordable Care Act is paid for; ready to go with minimal cost sharing to states and already working in more than half the country. It is a proven option available immediately, a crucial difference from any other proposed solutions.
One more important fact the “harmful Medicaid” myth ignores: Medicaid consumers like their coverage. In a recent national Gallup poll, 76% of those covered with Medicaid think the health system treats them fairly compared to only 36% of those who are uninsured. In fact, people feel better about Medicaid than they do about private insurance. So, the Medicaid program that is supposedly so harmful is actually wildly popular with those it serves.
Making the “harmful Medicaid” argument is not only completely baseless in fact but it also ignores real human suffering. Mindful of this, Utah’s Catholic bishop, the Rev. John C. Wester, called for Medicaid expansion last week: “Right now an opportunity to protect the dignity and sanctity of human life in Utah is being squandered by legislators who refuse to act in a morally responsible manner.”
