As emergency room doctors, we see the impacts of health care policy decisions first-hand. Gov. Mike Dunleavy is proposing to dismantle a large portion of the Medicaid program. The Legislature should consider what would it mean to implement cuts that would remove close to $800 million between state and federal dollars, or one-third of the entire program that covers 210,000 Alaskans.
The ER is the safety net for our society’s health care needs, and Alaska’s ER doctors see when the systems is working and when it is broken. Slashing the health care budget and denying tens of thousands of Alaskans access to health care will devastate the progress made over the last few years with Medicaid reform and expansion.
Prior to 2016, ER doctors frequently saw patients who delayed medical care because they could not afford insurance despite having a job, and could not qualify for Medicaid. Patients who were developing heart failure who showed up when they could no longer breathe from the fluid building up in their lungs. Women who presented with metastatic breast cancer because of an open wound from a tumor breaking through the skin. In the ER, we wouldn’t even ask why patients didn’t come in earlier, before they had a life-threatening problem. We knew the answer — “I don’t have insurance, I couldn’t afford it.”
In 2015-2016, a bipartisan effort led to the passage of Senate Bill 74. This was an ambitious project to redesign Medicaid in Alaska. Alaska’s ER doctors participated in Medicaid redesign to help drive down costly, unnecessary ER visits. SB 74 has led to improving primary and specialty care access, behavioral health access, care coordination projects and access to opioid and alcohol abuse treatment to many who were previously uninsured. SB 74 brought the Emergency Department Information Exchange, a powerful tool paid for by the hospitals, to help ERs avoid duplicate care and smooth access to the Prescription Drug Monitoring Program to help avoid excessive or potentially dangerous opioid prescriptions. Newly insured Alaskans have access to primary care, allowing care for and prevention of chronic medical issues, avoiding costly trips to the ER. Seventy-nine thousand more Alaskans are covered by Medicaid at the same cost to the general fund as in 2015. Just as we start to see the first real benefits of SB 74, these sweeping cuts threaten all of our progress and future benefits from Medicaid reform.
So what happens when one-third of the Medicaid budget is cut? Smaller regional clinics and hospitals will be at risk of shutting down or significantly cutting services. Not only does this threaten both rural and urban access to care for all residents, but it also threatens thousands of health care jobs across the state, destabilizing our economy. Alaska Regional Hospital just announced its plan for a Mental Health Unit is on hold until Medicaid funding is stable and adequate.
Thousands of Alaskans will lose access to primary care, forcing them to seek care in emergency rooms where care is more costly, and where doctors and nurses are trained to focus on the emergent issue, not in health maintenance and preventative medicine. Unpaid ER and hospital bills force us back to the days when more costs were shifted onto the private insurance market, making private insurance premiums even higher.
Medicaid covers 92,000 Alaskans 18 and under, as well as many pregnant women. Cut one-third of the budget and you threaten services to half the children in Alaska. Medicaid covers long term care for seniors. Cut one-third of the budget, and what happens to nursing home and long-term care residents when their Medicaid goes away?
Access to drug and alcohol rehabilitation programs and suboxone clinics is helping bring many Alaskans out of the darkness of addiction. Reentering the workforce becomes possible, families can stabilize and property crime goes down. In the Mat-Su area, ER prescriptions for opioids are down 80 percent in 4 years, and peer-to-peer counseling is available 24/7 for patients who want to stop using narcotics. SB 74 made that change possible. Cut Medicaid and although prescribing will stay low, many treatment options go away, and those committing crimes to feed their addictions will make our communities less safe.
Drastically cutting Medicaid will not only harm the health of many Medicaid recipients, but it will also harm health care delivery to all Alaskans. We recognize there is a debate about how to fund Alaska’s future. If we choose not to pay for this healthcare now in a coordinated, planned system, the money will still need to be spent at a higher health cost to those who can’t pay, and a higher financial burden to those who can pay. Let’s choose to make Medicaid more efficient by continuing the reform process, improving care coordination, access to primary care, behavioral health and addiction services. Let’s choose to continue to make Alaska a healthier and safer community for all Alaskans.
Dr. Ben Shelton and Dr. Andy Elsberg are emergency doctors practicing in Anchorage. Shelton serves as the president of the Alaska Chapter of the American College of Emergency Physicians.
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