Maisel in the Miami Herald: Florida Should Agree to Medicaid Expansion

In the following op-ed that appeared in the March 3, 2013, edition of the Miami Herald, FIU Law Professor Peggy Maisel makes the case that Medicaid expansion is the right thing to do in Florida.

Florida should agree to Medicaid expansion

by Cheryl L. Holder and Peggy Maisel

Fifty-year-old Miami-Dade County resident Mr. G worked every day. “I have always provided for my family,” he says proudly. Unfortunately, his job provided no health insurance and he and his wife could not afford to pay for the family plan at her job.

When he started losing weight and feeling weak, he went to a Broward County hospital ER where, with a white blood cell count near 1,000,000 and golf ball sized lymph nodes, he received the diagnosis of Stage IV Chronic Lymphocytic Leukemia. The hospital stabilized his condition and discharged him to continue care in Miami–Dade County.

With no health insurance, he then waited one month for an appointment in the Jackson Clinic and even longer to see an oncologist, both of which worsened his prognosis from 72 months (stage 1) to 19 months (stage IV)

Mr. G’s story is typical of those that we see every day as faculty members at Florida International University who supervise teams of students in the Green Family Foundation Neighborhood Health Education Learning Program (GFFNHELP).

At GFFNHELP students from FIU’s Medical, Nursing, Social Work and Law Schools work together with low-income, generally working households in Miami-Dade, who have been referred by religious and community organizations because they have serious healthcare needs.

As a result, we welcome the news that 63 percent of Florida residents polled want the Legislature and governor to accept the federal dollars that will pay 100 percent of the cost of insuring many of those who currently cannot afford health insurance. (The 100 percent federal reimbursement lasts for three years, and after that the state will never have to pay more than 10 percent of that cost in any year.) The expansion will also create an expected 65,000 new jobs over six years.

If our legislators follow the people’s wishes, 1 million Floridians, like Mr. G., who cannot afford to pay for doctors and struggle to stay healthy enough to attend school or work, will have access to the care they need and deserve. Like those of us with insurance, they will be able to receive medical care before they are so ill that they end up in an emergency room.

Florida only provides Medicaid to poor children and poor adults 18 to 64 if they are pregnant or permanently and totally disabled or if they have a minor child and make less than 20 percent of poverty (less than $303 a month for a family of three). Even with the new Affordable Care Act next year, unless the Florida legislature accepts the federal dollars to expand Medicaid, there will be no Medicaid or health insurance for the 1 million poor adults not in those groups.

Our recent survey of 200 GFFNHELP households showed 45 percent of them do not have health insurance and would be covered by Medicaid if the state accepts the expansion dollars. Many work in low-paying jobs (make less than 138 percent of the poverty level), have conditions such as diabetes or hypertension, requiring healthcare, but can’t afford to see doctors, buy medications or pay for hospitalizations.

Many have accumulated high medical debt as a result of their emergency room use or hospitalization, resulting in possible bankruptcy, losing their homes and risking future hospitalizations because they cannot buy medications.

Sen. Marco Rubio aptly stated during the response to the State of the Union that changes are needed “so that government can afford to help those who truly can’t afford to help themselves.”

Mr. G and our GFFNHELP adults are examples of those who tried to do things right. They work but they still cannot afford to purchase health insurance. These are the folks who will be covered by Medicaid expansion. The result will be to help keep them alive as contributing, taxpaying, and voting members of our community, while the rest of us will save money in the long run and good paying jobs will be created.

Peggy Maisel is a professor of law at FIU and founded the College of Law clinical program in 2003. Dr. Cheryl L. Holder is an associate professor in the Department of Humanities, Health and Society at Florida International University’s Herbert Wertheim College of Medicine.

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