The Pulse

The best editorial of the weekend: A physician explains the “desperation” NC’s Medicaid expansion blockade has caused

By: - April 25, 2022 12:15 pm
North Carolina’s refusal to expand Medicaid is a cruel experiment that’s caused large numbers of premature and unnecessary deaths, write physician Steve Luking. Image: AdobeStock

If you haven’t already, be sure to catch the extraordinary essay that veteran Rockingham County physician Steve Luking penned for the Greensboro News & Record over the weekend. In “As lawmakers wait; people are dying,” Luking makes plain in straightforward human terms what statistics have shown repeatedly over the last decade as Republican legislators have refused to follow the lead of most other states by expanding Medicaid to cover uninsured lower income North Carolinians: the decision is quite literally killing people.

And, not surprisingly (at least to anyone with a heart and a brain) the pandemic has made things much worse — especially in rural areas like the ones he served for three decades. After describing how he and his brother/medical partner set up open-air tents in 2020 to deal with the influx of COVID-19 patients, Luking writes this:

If legislators had stood at my side as I cared for the uninsured sick, many who were essential workers, I think they would reconsider their votes against Medicaid expansion. More than one in eight essential workers are uninsured in our state. Expansion would have provided basic coverage for many of them.

For instance, a single mom with two children, Dianne (patients’ names have been changed to protect their privacy) worked in a local grocery store. She had lost her Medicaid coverage when she was hired. She did not qualify for insurance, and so she was stuck, essentially uninsurable.

I saw Dianne one day in my tent, early in the pandemic. She had a fever and a bad cough, and felt miserable and scared. Several co-workers had come down with COVID.

The swab was positive. She told me she couldn’t pay for it so I gave her a loaner oxygen monitor, and watched her leave to pick up her kids at school.

Very early in the pandemic, before we had office-based testing, I also saw a feverish, uninsured farmhand. He was wheezing and appeared potentially unstable. When I advised him to go to the ER, he shook his head no.

“No insurance, can’t afford it,” he said. He drove away, undiagnosed.

Another uninsured patient was an aide for an elderly client who was hospitalized with COVID-19. She, too, developed a fever and cough and rapid breathing, but refused to go to the ER because she already had a prior thousand-dollar bill.

What kind of society demands that essential workers keep working in a dangerous pandemic, while squarely rejecting their access to insurance?

Luking then goes on to take comfortable lawmakers, like Greensboro’s Rep. Jon Hardister, to task for their offensive statements about not expanding Medicaid to “able-bodied” people — a term that probably holds superficial appeal with right-wing focus groups, but makes no sense at all in the real world. Here’s Luking:

Historian Steve Hindle notes that the use of “able-bodied,” though ostensibly “a physical distinction,” “always implies a moral one, and that’s why politicians use it.” Legislators who oppose Medicaid expansion routinely use the phrase, implying that those who fall into the gap are somehow less deserving.

In our society, women are more frequently stuck on the lower rungs of the income ladder for so many reasons; I can think of a dozen but here are two: They are paid less than men for identical work and they disrupt their work far more frequently for family caregiving, etc. Earning too much to qualify for Medicaid, they earn too little to qualify for private insurance. Living paycheck to paycheck, they suffer the consequences.

Luking then explores the heartbreaking stories of some “able bodied” patients to which he’s had to attend, who didn’t stay that way for long without insurance and concludes by likening their situations to that of drug trial participants who get the placebo, rather than what turns out to be a powerfully effective cure.

In clinical studies, researchers have the right, in fact, the moral obligation, to halt an experiment if the ongoing results reveal that continuation poses substantial risk of harm or death to the participants. We passed that point in North Carolina years ago. Willful ignorance of the death and suffering from the lack of Medicaid expansion is unconscionable, now just a hollow partisan exercise stained in blood.

Our citizens and our communities have suffered enough.

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Rob Schofield
Rob Schofield

Editor Rob Schofield oversees day-to-day newsroom operations, authors regular commentaries, and hosts a weekly radio show/podcast.