Looking through the medical chart in the emergency department, it was clear before even seeing her that Ms. C would be admitted to the hospital today. Her blood sugar was four times the normal value, and her blood tests were starting to show signs of diabetic ketoacidosis, a dangerous condition that arises when the body does not have adequate insulin to usher carbohydrates into its cells.
As I entered her room she looked up with a tired smile. I learned that she had lost her insurance two months ago when she was laid off from her job. Without health insurance, the cost of her insulin — a drug that has been in use for nearly 100 years and costs pennies to make — had skyrocketed to over $200 per month. Unable to afford her medications and still provide for her two children, she had been giving herself just half of her prescribed dose in order to stretch out her remaining supply.
Now uninsured, she was unable to make an appointment with her primary care doctor when the tale-tell symptoms of high blood sugar developed, and she had no choice but to come to the emergency room. Her greatest concern was that she would lose the part-time job she had just acquired if she had a prolonged hospital stay.
Stories like Ms. C’s play out in emergency departments across the state and the nation every day, disrupting lives, harming people and costing our health care systems vast sums of money. In Ms. C’s case, her hospital admission would likely cost thousands of dollars (not counting the societal cost of missed days of work and school for her and her children) and could have been prevented had she been able to access a few dollars’ worth of her prescribed insulin.
More discouraging still, Ms. C had no means to acquire health insurance before her hospital discharge, setting her up for a tumultuous pattern of emergency department visits and hospital readmissions as she was no longer able to access the necessary resources to manage her diabetes.
For many people caught in this chaotic cycle, holding a job is nearly impossible. Stable health has to come before other societal roles can be filled. That is why the backwards logic of Medicaid work requirements, based on a harmful myth that Medicaid recipients are lazy and unwilling to work, stands to cause great harm if enacted in our state.
Indeed, we just need to look at last year’s catastrophic experiment with work requirements in Arkansas for a preview. The program cut off insurance benefits from thousands of Arkansas’s Medicaid recipients — many of whom were meeting the work requirement and were simply confused about how to do the required reporting — before ultimately getting stymied in the federal courts. Yet, with no infrastructure to help people re-enroll, the majority of those affected remain without insurance, especially in rural areas. There were no winners, just failed policy causing human suffering.
Yet as Utah lawmakers regroup in the wake of SB96’s rejection at the federal level, they have expressed intent to continue pursuing work requirements and other unproven barriers to insurance access for Utah’s most vulnerable groups.
As a physician who is privy to the immense societal costs and personal harms that arise from being uninsured, unrestricted Medicaid expansion is an obvious choice. We know that it improves the health of communities, reduces health care spending at the state level and reduces health disparities by looking at rigorous studies from over 30 other diverse states that have gone before us.
We also know that experiments with restricting access such as Arkansas’ work requirement mandate have failed, hurting people along the way.
As we move on to the Legislature’s first contingency plan for implementation of Medicaid expansion in Utah, we need to again make sure our voices are heard loud and clear: Good health and compassion are priorities for Utahns, without restriction.
Michael Incze, MD
Michael Incze, M.D., MSEd, is a a member of the faculty at the University of Utah School of Medicine and a primary care physician at the University of Utah with a clinical interest in homelessness, addiction and health disparities. The views expressed here are his own and not necessarily those of the University of Utah.
