GUEST COMMENTARY

Our Health Care System is Struggling. Kicking People Off Medicaid Will Only Make It Worse.

By: Dr. Karen Gersch, Cardiothoracic surgeon with Georgia Heart Institute in Gainesville, GA

As a cardiothoracic surgeon, I am often treating patients in moments of crisis. My job is to help people heal, and when I’m scrubbed in performing a surgery, the common denominator across my thousands of patients is that they are human beings who deserve to be treated with compassion and dignity. But there is only so much that front-line providers can do to ensure that our patients are afforded such care, because too often we are hamstrung by bureaucratic directives coming out of Washington. The proposed changes to Medicaid currently being debated in Congress are no exception and would only exacerbate the challenges that are plaguing our health care system today.

The language being used in the current policy debate around Medicaid is a trap of divisive rhetoric that sets up a false dichotomy of “us vs. them” — the “us” being those who deserve health insurance and the “them” being people who don’t. But should politicians in Washington be making that moral judgement call? Looking at me today as a successful surgeon and community leader, I’d most certainly be put in the “us” category. But when I was a young girl, I almost assuredly would have been seen as a “them.” My family are poor farmworkers in eastern North Carolina. Almost no one in my community could afford health insurance, despite spending their lives doing strenuous labor that helped put food on the plates of people across our state and country. And while I understand that the intention of Republicans in Congress may not be to keep families like mine from getting health care coverage, the reality on the ground is that blue collar and nontraditional workers will be the ones who suffer if the House-passed reconciliation bill becomes law. 

Take work requirements, for example. I practice medicine in Georgia, the only state that currently implements a work requirement through its Medicaid program, Georgia Pathways. It is an administrative nightmare. And it’s incredibly fiscally irresponsible. Today, fewer than 7,500 Georgians are enrolled in the program after two years of implementation, far short of the roughly 30,000 people our state government estimated would be covered after year one. What’s worse, the program has cost Georgia taxpayers over $91 million, with the vast majority of those tax dollars going towards administrative and consulting costs, and not actual healthcare services for Georgians. That means that the cost per enrollee is over $12 thousand. 

Enacting such changes at the federal level would bring similar administrative and financial barriers across the country, leading to more people being uninsured, even though they should qualify. For many families like mine in North Carolina, they simply do not have the resources or bandwidth to figure out complicated layers of paperwork and reporting requirements while still doing the actual work that qualifies them for coverage. Similarly, entrepreneurs, seasonal, contract, and gig economy workers have irregular schedules that may result in their paperwork disqualifying them from coverage in certain reporting cycles when they are working less, even though they should qualify based on the average they are working over the course of a year.

The Congressional Budget Office estimates that if the House-passed reconciliation bill becomes law, 10.9 million more people would become uninsured. I see the impacts of people lacking access to health care coverage every day in my hospital. Georgia has one of the highest rates of uninsured people in the country, and because of that we are missing opportunities to provide preventive services and recognize concerning symptoms earlier in the disease process. I end up performing expensive surgeries, blood transfusions, and overseeing long hospital stays for people who could have avoided such intensive treatments if they had simply been seen by a provider sooner. I share the goals of the Administration to increase the health care system’s focus on preventive care and chronic disease prevention, but creating policies that make it harder to access health care coverage will do nothing to support that worthy aim.

Similarly, if the intention of proposed work requirements is to incentivize a more productive labor force, Congress is missing the mark. A 20-30 year old with diabetes who loses his Medicaid coverage as a result of his contract employment schedule is very likely to show up in my office at age 45 after suffering from a heart attack. As a result, that patient is likely to become disabled and have no choice but to leave the work force. I see it all the time. Such patients cost our health care system more, and put more pressure on already burnt-out provider teams. It also means that hardworking people are no longer able to provide for themselves and their families. 

The ripple effects of such policies are broad, and not only will millions of people lose their health care coverage, but entire communities stand to lose their access to care if rural hospitals are forced to reduce their services or close as a result. It’s estimated that the policy changes in the House-passed reconciliation bill would increase hospital uncompensated care costs by at least $42.4 billion in 2034, and we know that higher rates of uncompensated care are more likely to impact rural hospitals. When a rural hospital closes, thousands of jobs are lost, further exacerbating unemployment and the need for more people to be using federal assistance.

Those of us on the front lines of health care are asking Congress to see through our eyes and understand that creating barriers to health care coverage will not solve the problems in our health care system. It will only exacerbate chronic disease progression, increase levels of burnout among providers who face increasingly complex cases that could have been prevented, and drive health care spending up. Health care is fundamental to vibrant, productive communities. Congress should vote no on any legislation that would result in widespread disenrollment from Medicaid, not only because it’s in line with the compassionate and dignified care we are trained to deliver for our patients, but also because it supports a stronger economy and workforce.