My last nine years of employment at Huntsman Cancer Institute were the most poignant of the 45 years I worked in and around the health care industry. I did intake for newly diagnosed cancer patients, taking calls from either the patients themselves or the physicians who referred them.
Two of those patients still bring tears to my eyes when I think of their stories. Both were women who were diagnosed with stage IV breast cancer only after bone metastases caused “pathological fractures.” One woman died a few days after she was referred to Huntsman and the other endured aggressive treatment for nearly a year before dying.
Both these women worked their entire lives at various low-paying jobs but never had health insurance. They both would have benefited from Medicaid expansion that would have covered annual health screening, mammograms and treatment at an early, curable stage of cancer. The cost for this is modest compared to aggressive last ditch efforts.
Utah state Sen. Allen Christensen, R-North Ogden, and state Rep. Jim Dunnigan, R-Taylorsville, are convinced that Medicaid expansion, as funded by Proposition 3, will run $45 million short by the year 2023 and they need to repeal or add work requirements (which discourage enrollment and are expensive to monitor and administer). There is also talk of reducing eligibility from 138 percent of federal poverty level ($17,000 per year) to 100 percent ($12,000 per year).
The Kaiser Family Foundation in a literature review of the states who have already expanded Medicaid as intended by the Affordable Care Act, published these findings March 28, 2018:
• Expansion is associated with infant mortality rate reductions, increases in cancer diagnosis rates (especially early-stage diagnosis rates), increase in prescriptions for medications to treat opioid use disorder and opioid overdose and reduced probability of hospital closure (particularly in rural areas)
• Expansion was associated with improved quality on four of eight measures examined: asthma treatment, Pap testing, body mass index assessment, and hypertension control.
• Expansion results in reductions in uncompensated care costs for hospitals and clinics, as well as positive or neutral effects on employment and the labor market
• Expansion’s effects on operating margins were strongest for small hospitals, for-profit and non-federal-government-operated hospitals, and hospitals located in non-metropolitan areas
• National research found that there were no significant increases in spending from state funds as a result of Medicaid expansion and no significant reductions in state spending on education, transportation, or other state programs as a result of expansion during FYs 2010-2015.
A 2018 report for the USC-Brookings Schaeffer Initiative by Mark Hall analyzed five years of data from the states that expanded Medicaid following implementation of ACA. They found that one reason new enrollees do not substantially burden states’ Medicaid budgets is that expansion absorbs some of the extra costs states were already bearing prior to expansion.
A 2017 New England Journal of Medicine article concluded that, “federal funding for Medicaid expansion offers states a fiscal benefit through reduced state spending on Medicaid-covered services and a macroeconomic benefit through increased economic activity and redirected personal spending.”
Seriously. If only we could rename Prop 3 the Inland Port or the Wetland Prison, I am sure the funds could be found. There is an abundance of evidence that this can be done.
Christine B. Helfrich
Christine B. Helfrich, Millcreek, remembers that, when she was a young mother, college student and low-paid employee, Medicaid paid for her three hospitalizations in 1968-69. She has been a grateful taxpayer ever since.
