Denying poor people health care defies logic

Gov. Rick Scott should expect more confrontations like the recent one in a Gainesville Starbucks because he continues to lead this state in its rush to abandon health-care services for poor citizens.

It’s outrageous that Gov. Scott, his Republican supporters and other Republican state governors have refused to provide expanded coverage to low-income adults, even though the Affordable Care Act authorizes the federal government to pay most of the cost of this expansion in the Medicaid program.

The decision by 25 states to reject the expansion of Medicaid coverage under the Affordable Care Act will result in between 7,115 and 17,104 more deaths than had all states opted in, according to researchers at Harvard Medical School and the City University of New York. The researchers found that because of the states’ “opting out” of the Medicaid expansion, 7.78 million people who would have gained coverage will remain uninsured.

In addition to the thousands of excess deaths associated with that lack of coverage, the rejection of the Medicaid expansion will have the following likely impacts:

• 712,037 more persons diagnosed with depression

• 240,700 more persons suffering catastrophic medical expenses

• 422,533 fewer diabetics receiving medication

• 195,492 fewer women receiving mammograms

• 443,677 fewer women receiving pap smears

In Florida, more than 309,000 uninsured citizens with a mental illness or substance-use disorder had incomes that could qualify them for expanded Medicaid under the Affordable Care Act in 2014, according to a recent report urging state officials to expand Medicaid. The U.S. Department of Health and Human Services report shows that under the Affordable Care Act, Florida would greatly improve access to behavioral health services for its residents.

While Florida has a very high percentage of its citizens uninsured, and an even larger number under-insured, the disconnect between this public need and the political/social will to change things is sharp. Republican obstructionism promotes inaction of the electorate, who in Florida suffer from a combination of being uninformed or misinformed and unable to advocate effectively for policies that would benefit all.

If Florida expanded Medicaid, 69,000 fewer individuals would experience symptoms of depression and 100,000 more people would report being in good or excellent health. Expanding Medicaid is advantageous for behavioral health because it will allow people to get the care they need and opens new opportunities to meet other pressing mental health and health care needs.

The toxic combination of the voting public being uninformed/misinformed/unaware led to the election of Rick Scott in the first place. Everyone now recalls that Gov. Scott is a billionaire businessman who formerly was the infamous CEO of Columbia/HCA.

Columbia/HCA was fined $1.7 billion for perpetrating the largest Medicare fraud in the entire history of the Medicare program. During the investigation, Scott testified that he was “unaware” of all this while CEO. Gov. Scott’s “unawareness” continues apace in his Florida Medicaid policies.

In an age when we are supposed to be a society that cares enough to see that all of us receive the health care that we need, we still have among us those who insist that people with no assets — often homeless and frequently missing meals — are supposed to exercise “personal responsibility” by paying funds that they don’t have as a condition for receiving much needed medical care. It is completely irrational and inhumane to have consumer-directed, moral hazard-based policies that erect financial barriers to care for the four-fifths of the Florida population with minimal or modest resources.

Scott’s policy clearly exposes the colors of these “reject Medicaid expansion” advocates. What kind of people are we that we elect individuals like this to take charge of our federal and state governments?

Denying poor people basic mental health, medical and dental care simply because they cannot pay the premium defies logic. Does sentencing poor people to receiving little or no mental health care truly motivate them to find money that they don’t have in order to provide them with the “dignity to pay for their own health insurance”?

After we expand Florida Medicaid today, tomorrow we need the federal government to finance a nationwide, not-for-profit, one-tier system of universal, single-payer coverage, based on medical need and not ability to pay. This would resolve persistent problems of failed market policies, and would resolve what Martin Luther King, Jr. once described: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Written by F. Douglas Stephenson
Originally published at
Published: Wednesday, April 13, 2016 at 6:01 a.m.
Last Modified: Tuesday, April 12, 2016 at 4:34 p.m.

— F. Douglas Stephenson, LCSW, BCD, lives in Inglis and is a former president of the Florida Society for Clinical Social Work.

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