COVERAGE: The Bigger Picture on Medicaid and Congress

Congress and the President are doing battle yet again about Medicaid , and NPR's Julie Rovner explained in a nice piece this week why we all should care. She illustrated a point we've made ourselves about why insurance matters: the uninsured place an additional burden on already over-taxed Emergency Departments, affecting the quality of care for all of us.

Specifically, the costs associated with uncompensated care for the uninsured and underinsured, and Medicaid underpayment cause many EDs to either close or drastically scale back the number of emergency beds. In fact, between 1993 and 2003, 425 emergency departments closed nationwide. Median ED waiting times for the insured and uninsured increased by 36% between 1997 and 2004.

Rovner drove this point home by recalling some particularly moving testimony Dr. Angela Gardner, Vice President of the American College of Emergency Physicians and an emergency doctor from Galveston, Texas, made before the House Oversight Committee last fall. If you missed Gardner's testimony, here's a must read excerpt:

I worked in the emergency department on Tuesday night, and on my arrival all 48 of my beds were full. We had 22 patients in the hallway. We had 14 patients in the waiting room. We had three ambulances unloading and two helicopters waiting to land. That is a normal day. ...

At midnight I got a patient who arrived to me comatose from the back seat of his mother's car. He had been driven 250 miles to my emergency department to get our care. I will call this man Norman to preserve his privacy. Norman had been having headaches for about a month.

On the third week, when his right hand wouldn't work any more and he started vomiting, his mother said, you have to go to the hospital. They went to the emergency department at their local hospital, where he was diagnosed with a brain tumor on the left side of his brain. ...

After waiting eight days for his bed in the hospital there in his home town, Norman, in pain and vomiting and unable to move out of that bed, begged his parents to take him home to die, and they did. He went home to die, and when he became comatose his mother loaded him in the back seat and brought him to me. I put him on a ventilator. I gave him drugs. I got him a neurosurgeon. What I could not get him was a bed....

I do not know if Norman died, but I believe that he will die in that trauma bay. He will never see the inside of a hospital. He will have his neurosurgeon, but he will not have a bed.

As you sit here and absorb the impact of the story, I would like to let you know something. Norman is not indigent. Norman is a working man with health insurance. The problem with the cuts that Medicaid wants to make, the cuts to Medicaid that are being proposed, is that it affects not only the indigent but everyone out there. This could happen to you, it could happen to someone that you love.