Last year, Mahana Fisher had a patient come to his office with a sore on his backside that wouldn’t go away. It had lingered for nine months by then because the gentleman had a hard time scraping together enough money to see a doctor.
It ended up being cancer and required a series of surgeries and chemotherapy for a malady that could easily have been nipped in the bud.
It’s those types of cases that Fisher said he has seen too often during his years practicing medicine in rural Utah — 17 working at clinics in San Juan County and, since last year, at a clinic in St. George.
“The one thing we’re trying to promote in this whole nation is preventive care,” Fisher said Tuesday. “Studies have shown, if you prevent [disease], you save money in the long run. … It’s both financially more feasible as well as providing better patient care.”
But for thousands of rural Utahns without health insurance, health care is out of reach or is put off until it becomes a dire threat.
Thirty-one percent of adults in rural counties do not have access to insurance, whether it’s because of high unemployment, or they are self-employed, or they do seasonal work and don’t get insurance, according to a recent study by the Georgetown University Center for Children and Families.
In Uintah County, a third of the adult population doesn’t have health insurance; in San Juan County, where Fisher worked, more than 2 out of every 5 adults are uninsured.
The gap between coverage among rural Utahns and urban Utahns is the second highest in the country, Joan Alker, a research professor at Georgetown and co-author of the study, told me Tuesday.
That has repercussions for those in rural areas who do have insurance, she said. If one looks at a map of which hospitals have shut down across the country, they are almost exclusively in rural parts of states that did not expand Medicaid, because those are the ones providing the most uncompensated care.
That means a pregnant mother with insurance, for example, would have to travel farther to deliver a baby or get postpartum care.
But it doesn’t have to be that way. The study also looked at states that did opt to expand Medicaid, which provides coverage to more people who are poor, and found that rural counties in those states saw their rates of uninsured fall by more than half, from 35 percent to just 16 percent.
Which brings us to Proposition 3, a Utah ballot initiative that would extend Medicaid to those adults earning up to 138 percent of the federal poverty level — less than $17,000 for a single adult or about $35,000 for a family of four.
The Medicaid expansion initiative has been overshadowed in a big way by all the attention heaped on the medical marijuana initiative, but they have quite a bit in common.
Both are on the ballot thanks to voters fed up with legislative inaction — for years Republican lawmakers beat back efforts by Gov. Gary Herbert to expand coverage to low-income Utahns and in the process turned back an estimated $800 million per year in federal funding.
If Utah were to expand Medicaid, it would translate into an estimated 150,000 people statewide who wouldn’t have to live in fear of getting sick and could lead healthier, more productive lives.
It comes with a small sales tax hike — about 15 cents per $100 we spend, or the change that is probably in the cupholder of your car right now.
In spite of what might seem like a compassionate, common-sense case to support the measure, there is a decent chance it won’t pass. The most recent poll, conducted for UtahPolicy.com, found that 54 percent of Utahns are supporting the proposition with 35 percent opposed.
Historically, we’ve seen ballot initiatives nationwide, particularly those that raise taxes, go down in defeat when they head into Election Day hovering just above 50 percent in the polls.
Not surprisingly, a Salt Lake Tribune-Hinckley Institute poll conducted last fall found that opposition to expansion is strongest in rural areas of the state (and in Utah County) — exactly the areas that would benefit the most from passage of the measure.
And we haven’t even really seen a concerted push against the Medicaid initiative, although you can expect it will come. The Utah chapter of the dark-money group Americans for Prosperity, funded largely by the Koch brothers, with a national network and a budget of more than $66 million, has been doing some small-scale campaigning against the initiative.
The group previously ran a devastatingly effective campaign against Healthy Utah, threatening legislators with a barrage of campaign attacks if they voted to expand the insurance program, and it’s safe to assume it will be stepping up its presence in the coming weeks.
How voters decide this one probably says a lot about who we are as Utahns. Are we willing to kick in a few bucks each year and bring hundreds of millions of our tax dollars back to the state to help make sure a substantial portion of Utah’s working poor are able to see a doctor when they get sick?
Or do we put politics before compassion as the Legislature did and turn our backs on the suffering of our neighbors, especially those in rural Utah?
