The My Turn written by Bethany Marcum “The hard truth about Medicaid expansion” published on Feb. 20 in the Juneau Empire contained only two truths: Alaska expanded Medicaid in 2015 and the author would like to see a work requirement added to Alaska’s Medicaid program.
The remainder of the article was a mixture of inaccurate, misleading and inflammatory statements. While we should have a robust discussion about how to help the employable, but currently unemployed, adults who are on Medicaid find a job with a livable wage the author’s article does not move us in that direction. Rather it stokes the fires of inflammatory self-righteousness against Medicaid expansion in Alaska. Marcum acknowledges that “the number of able-bodied adults not working here in Alaska isn’t currently available” but then goes on to speculate, weaving in senseless references to Nevada and Kentucky (somehow forgetting to mention Kansas) to make her point.
Which is what? That Medicaid is welfare? That access to health care is a dependency trap? This sort of polarizing rhetoric hinders, if not prevents, a rational discussion about an important topic. Therein lies its wickedness.
Medicaid in Alaska allows access to health care. It does not provide food, housing or income.
Having access to health care prevents dependency, not causes it. Providing health care allows for prevention of illness; for example, treating hypertension so that someone does not have a stroke. Providing health care for Alaskan’s also allows them to stay healthy enough to continue to work.
Most of the adult patients that I see who have Medicaid are working. But the jobs they work at do not provide health insurance and do not provide a livable wage. They are the working poor. There is the minister with a wife and several young children without private health insurance and an income barely above the poverty level. There is the woman with rheumatoid arthritis who can no longer do the work she previously did and is searching for new employment. There is the woman with a history of a closed head injury who has been hired and let go from two jobs because of the residual effects of that head injury. There is the auto mechanic in recovery from heroin addiction struggling to get back on his feet.
Without Medicaid they would not be able to get the medical care they need to be working members of our society. Denying them this care would make them dependent. It would be mean spirited. It would not benefit anyone. The vast majority of my able-bodied adult patients who are on Medicaid want to work. So let’s help them; by creating bridges to work, not imposing bureaucratic barriers to aid. Developing a connection between Medicaid and the DVR comes to mind as a bridge to build.
The hard truth is that the feds paid for the entire cost of the Medicaid expansion through 2016, every last dime. Approximately $1 billion in federal funding has been paid to Alaska’s health care industry as a result of the Medicaid expansion. The state began paying 5 percent of the cost in 2017 and that will gradually increase up to 10 percent by 2020, stabilizing at that level.
That is a nine times return on Alaska’s investment in the health care of its citizens. We need to figure out how to cover the cost of that 10 percent investment. That is the discussion we need to be having.
• Dr. John E. Pappenheim is a Juneau resident and physician who practices here, specializing in psychiatry and addictionology.