Justin never thought he’d live past the age of 25. In just nine months, he’ had already received emergency care for his diabetes four times.
A new family medicine physician changed all that. With regular primary care, Justin took medication and changed his diet and exercise habits. Now he no longer needs to inject himself daily with insulin — or fear an amputation. Justin is now approaching age 30, in the best health he has experienced in years.
This might not have happened without his Medicaid coverage.
Now Medicaid and patients like Justin who rely on it are in the crosshairs. That’s because Republicans are looking for $880 billion worth of cuts over the next decade to help finance tax cuts for the wealthy. While the Republicans are not yet united behind an approach, they seem set on cuts.
As a doctor and CEO of a hospital and health care group who has worked in health care for more than 30 years, I know from experience that cutting Medicaid won’t make health care more accessible, affordable or efficient for anyone. In fact, it will do the opposite: It will harm urban and rural communities, affluent and poor alike.
Why? Because we are all connected in our health care system. When one part of the system struggles or fails, the burden is shifted to other parts of the system, crossing community boundaries.
Currently, Medicaid covers more than 80 million people, or about 21 percent of the population, including pregnant women, people with disabilities and many people in long-term care facilities. As a growing number of Americans — including many Republican voters — receive care that is paid for by this public insurance plan, it has become a critical foundation for maintaining health, saving lives and preventing medical debt. Medicaid improves the chance for a healthy birth. It provides better access to primary care — the most effective way to prevent illness and reduce costs.
Cuts to Medicaid will put additional pressure on stressed and overcrowded providers. Access to doctors and services, already limited in rural and poor urban communities, will become even worse. And I know one thing with certainty: If the federal government cuts back on care, people won’t stop getting sick.
Forced reductions in access through budget cuts will lead to patients delaying care and eventually arriving in emergency departments with advanced diseases. We may see temporary savings in one row of a balance sheet, but it will be an illusion, as costs for emergency and inpatient care increase.
Nearly half of hospitals in our country are operating at a loss. These hospitals are already cutting back on services — closing labor and delivery departments and eliminating staffing for patient beds. When these budget reduction measures fail, entire facilities may close, often those that serve the most vulnerable.
This is when the impact is felt in neighboring hospitals, as patients seek care outside of their communities, exacerbating crowding and delays in those facilities. We experienced this here in South LA, when King-Drew Medical Center closed in 2007. Facilities 10 to 20 miles away, including Cedars Sinai in Beverly Hills and UCLA Medical Center in Santa Monica, were forced to absorb patients who still needed care.
Health care may not be well organized, but it is interconnected. Pressure in one part of the system creates pressure in another. Some leaders may not be concerned about worsening care for poor communities, but as cuts reverberate through the system, privately insured constituents will also be affected. When providers are paid less for Medicaid patients, privately insured patients will pay more.
America spends more on health care than other wealthy countries while achieving worse outcomes. But the answer to high health costs is not to cut access for our most vulnerable communities. A health care system built on a foundation of public health, prevention and primary care would give us better health outcomes and cost less. Aligning payment with patient care rather than with corporate profits — the U.S. spends $804 billion each year on Medicaid where just five Fortune 500 companies account for half of the program’s enrollment — would cut waste while returning health dividends to communities.
Justin is an example of what we should be doing: making sure patients have access to primary care so they can stay healthy. Cutting services for some members of our society will impose a cost on all of us who need and use health care. It will make health care delivery less efficient and more expensive — the opposite of what leaders on both sides hope to achieve.
Elaine Batchlor is a physician with over 30 years of experience working in American health care and currently serves as the CEO of MLK Community Healthcare.
