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Physicians must fight to save Medicaid expansion


After receiving feedback on my previous blog, Medicaid expansion must remain safe in healthcare reform, I must continue to encourage that Medicaid, a joint federal and state program that funds healthcare for the poor, be protected.

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Lori E. Rousche, MD, a family physician in Souderton, Pennsylvania. She is also the hospice medical director for Grand View Health in Sellersville, Pennsylvania. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


Politicians are at it again-trying to save the healthcare system.


Further reading: Front-line physiciansn respond to AHCA vote


Although there is no easy answer, eventually changes will be made that conceivably will ensure the stability of insurance companies and Medicare, hopefully allowing access to care for most, if not all, Americans. 

After receiving feedback on my previous blog, Medicaid expansion must remain safe in healthcare reform, I must continue to encourage that Medicaid, a joint federal and state program that funds healthcare for the poor, be protected.

Lori Rousche, MD

Our most vulnerable neighbors need medical care. The Medicaid expansion as enacted under Obamacare helped to cover the working poor, young mothers, young adults and early retirees. Waiters and waitresses, sales clerks and fast food cooks are just some of the workers that might lose coverage with the new American Health Care Act (AHCA). The Medicaid expansion also protected some of our alcoholic, schizophrenic and otherwise disabled neighbors. If we live in an advanced civilization, which we presumably do, how can we not take care of those less fortunate?


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The House of Representatives passed legislation to repeal and replace Obamacare. It has many flaws, and we all know premiums continued to rise with this program. But, the new-and-improved version, Trumpcare, cuts off federal funding for the Medicaid expansion.

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Federal spending on Medicaid is expected to decrease by $880 billion over approximately the next 10 years. We all know someone, or are related to someone, who works in a profession that may be adversely affected by this change. With decreased access to care, there will be less preventative health exams, less prenatal services and less treatment of acute and chronic illness. It is projected that 14 million Americans will lose or drop health insurance in 2018 under the ACHA. Our most vulnerable patients will be denied care because it is not affordable. This is not a step forward.


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A study from Cornell and Harvard showed that children with access to healthcare (Medicaid and CHIP) had more success in school than kids that had no healthcare. The Medicaid expansion helped decrease income and race-based coverage disparities. Ultimately, the Medicaid expansion saves Medicare money down the road. The states that had the expansion under Obamacare offered coverage to people who were then able to get care for chronic conditions. Conditions such as hypertension, high cholesterol and diabetes are often untreated in patients who can’t afford health care, making the complications of these diseases more severe as the patient ages.

As with any free program, there will always be scoundrels to take advantage. But certainly not everyone who received coverage under the expansion was a bum. Most of the patients that I took care of at a free clinic who were able to get  Medicaid with the expansion in Pennsylvania were hard working laborers. Some were addicts or alcoholics and thereby unable to hold down full-time work and did not make enough money to buy insurance on the exchange. Others had physical disabilities, such as chronic back pain, that prohibited full-time employment, and these patients qualified for health insurance under the expansion. This segment of the population needs and deserves medical care.


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The current battle over Obamacare’s overhaul is off the back burner and in the news again. We await the Senate’s input on Trumpcare. Let’s hope that the offered replacement includes a humane proposal that includes ongoing Medicaid for our most vulnerable patients. Let’s protect those that need it. As a society, those that have need to help those that have-not when it comes to healthcare. Period.

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