Do you want to read about why it matters whether or not people have access to affordable health care? The Los Angeles Times has a piece that looks at what happens when a state expands access to health care and what happens when access contracts.
Among the Medicaid services [Arizona] cut four years ago was podiatry, an important benefit for diabetics, many of whom lose feeling in their feet and become more prone to infections as the disease wastes nerves and arteries.
At the University of Arizona Medical Center in Tucson, Dr. David Armstrong still sees the impact.
Nearly every day, Armstrong and Dr. Joseph L. Mills, who co-direct the Southern Arizona Limb Salvage Alliance, don surgical scrubs and step into an operating room to amputate limbs or cut away diseased bones and flesh of patients with diabetes who put off seeing a doctor.
One afternoon, Armstrong’s team labored to save the black, gangrenous left foot of a 30-year-old diabetic, sawing out infected bones, stitching healthy tissue and grafting skin in a bid to spare him life in a wheelchair.
“If it was just a couple of months earlier, we probably could have stopped some of these problems,” Armstrong said later. “We’re constantly shaking our heads.”
Armstrong and other researchers documented a 37% increase in hospital admissions for diabetic foot ulcers between 2006 and 2011, according to a study they published in the journal Diabetes Care.
Patients also stayed longer in the hospital with more severe outcomes, they found. Amputations, surgical complications, life-threatening infections and deaths increased by nearly half.
“These people’s feet were literally killing them,” Armstrong said.
What’s frustrating, he said, is that the solution is straightforward. “It doesn’t need big, fancy machines…. It’s just good, quality primary care.”
Of course, prior to gutting their Medicaid program in the immediate aftermath of the Great Recession, Arizona had greatly expanded access.
Pushed by doctors, civic leaders and hospitals — many from the more liberal Tucson area — voters approved ballot measures to dramatically expand Medicaid [in the late 1990’s], paying for it with Arizona’s share of a legal settlement between states and the tobacco industry.
In most states at the time, Medicaid was reserved primarily for poor children, mothers and the disabled. Arizona joined a handful offering coverage to low-income working-age adults, even if they didn’t have children.
The vote fueled the fastest Medicaid expansion in the country: Enrollment more than doubled between 2001 and 2010 to 1.3 million people.
In Tucson, that spawned new clinics and programs for the needy. It also appears to have improved residents’ health.
Mortality rates in Arizona, New York and Maine, which all expanded Medicaid between 2001 and 2003, fell 6% compared with neighboring states that did not expand, researchers found.
The decline was most pronounced in places with large poor populations such as Tucson and surrounding Pima County, where Medicaid probably had the biggest effect, according to the study in the New England Journal of Medicine.
And, guess what? Look what happened when Arizona turned around and expanded Medicaid again.
Many other Arizonans have gained coverage since January after Republican Gov. Jan Brewer’s push for Medicaid expansion. Enrollment surged 26% this year to more than 1.6 million, state figures show.
Although podiatry services haven’t been restored, the expansion of the safety net is already being felt.
At Tucson Medical Center, the number of life-threatening cases in the emergency room has declined.
Doctors instead are seeing more patients with severe headaches or abdominal pain. The symptoms can indicate a very serious condition, but uninsured patients often ignore them, fearing the high bills they may face.
At the hospital’s breast clinic, the waiting list for screening through the hospital’s charity program, which had been three months, is now half as long.
Officials at the Pima County jail have been busily signing up inmates for Medicaid all year. Capt. India Davis, the assistant corrections director, said officials expect the improved access to healthcare, especially behavioral health services, will not only lessen the burden on the lockup but also reduce recidivism.
This really isn’t complicated. We’re right; the Republicans are wrong, and even a wingnut like Jan Brewer knows it.
