Heidi Miller: Need to expand Medicaid more apparent than ever

As a primary care doctor, I cringe when I am paged on-call at 2 a.m. by a patient with chest pain who won’t go to the emergency department because of lack of insurance.

With sadness and frustration, I must persuade the patient that this is an emergency and he could die from a heart attack. Debating financial devastation versus life-saving care on the phone with a man in pain while the clock is ticking is a foolish injustice.

Our state has left more than 230,000 Missourians similarly without access to affordable health care. Catching a heart attack early or assuring health care to prevent heart disease in the first place is an obvious, humane and cost-effective strategy.

The plight of my uninsured patients is made even more bitter knowing that our tax dollars are currently going to Washington, D.C., to fund Medicaid expansion for 36 other states.

That can change now that petitions from nearly 350,000 Missourians asking the state to let voters decide on Medicaid expansion have been submitted to the secretary of state’s office.

The Healthcare for Missouri campaign on Friday submitted nearly twice as many signatures from Missourians as required, a testament to the widespread interest across the state in making this change.

With Medicaid expansion in Missouri, my patient whose waiter payroll taxes have been subsidizing health coverage for restaurant workers in other states can finally afford his asthma inhalers.

With Medicaid expansion in Missouri, my patient with a heart arrhythmia can finally attain her lifesaving blood thinner instead of skipping it to cover her rent.

With Medicaid expansion in Missouri, my diabetic patient won’t run out of insulin and incur a $5,000 hospital visit because of lethal glucose levels.

These are our patients: servers, delivery personnel, shuttle drivers, farm workers, home health aides and store clerks, most working at or near minimum wage, unable to afford insurance and needing their essential health to work their essential jobs.

Many are employed in service industries doing physical labor, which takes a toll on their bodies. I see medical issues interrupting my patients’ ability to perform their job duties. Limping to get through a shift perpetuates disability and impairs our economy.

And that was before the pandemic tragically reminded us that access to health care is more important than ever.

With Medicaid expansion, we can care for our own residents and our own economy, bringing more than a billion of our tax dollars back home from Washington, D.C., each year.

Three dozen other states have already done so, including our neighbors in Illinois, Kentucky, Nebraska, Iowa and Arkansas, where officials reported using savings from the expansion to enact a middle-class income tax cut and reduce payments previously allocated to the uninsured.

Every state that has expanded Medicaid has chosen to keep the program in place — in no small part because of the policy's positive economic impacts.

Never before in Missouri has the interdependence of our health been more apparent and the dependence of our economy on our collective health been more evident.

Medically, I recognize an emergency requiring immediate attention. Publicly, I recognize the dire and immediate need for increased health care access in this state.

Medicaid expansion will make our families healthier, our communities safer and our economy stronger. It will keep rural hospitals open, create thousands of new jobs and allow hundreds of thousands of hardworking Missourians with jobs that don’t provide insurance access to life-saving care.

Missourians would take the shirts off their backs to help a patient injured and bleeding in front of them. Likewise, I believe Missourians who see the current injured and fractured state of health coverage in our state will understand the need for Medicaid expansion.

Heidi B. Miller is a primary care doctor at Family Care Health Centers in St. Louis and medical director for the St. Louis Regional Health Commission.

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