Column: Refusing federal money risks needless asthma deaths

Published April 1, 2013

Have you ever seen a person die from asthma? I have. The first time, 15 years ago, I was a resident physician and a young woman arrived in the emergency room of our hospital, suffocating in front of our eyes. It wasn't the last.

I don't want a man I'll call William to be next. A patient of mine, he is 40 and works full time as a telemarketer. There is no reason for asthma to kill him, but if Florida refuses to expand Medicaid the chances are great that it could. He makes less than $16,000 per year and has no health insurance. His employer provides none, and he cannot afford to buy a policy on his own. He is not currently eligible for Medicaid because he is a single, childless and male. I see him for free, but I cannot provide his medications. If Medicaid were expanded, he would be covered.

For an uninsured William, asthma is a death sentence. We know his asthma requires daily controller medication and as-needed rescue inhalers, which cost upwards of $5,000 a year. That is nearly a third of what William makes. We know that without access to preventive care and medications, his risk is nearly 50-50 of being one of the nine people who die of asthma every day in the United States.

Last month I lost another young female patient to uncontrolled asthma. The disease accounts for more than $20 billion annually in health care costs and is the second most common chronic disease in the United States.

As a doctor who cares for hundreds of patients with asthma, I am disappointed in Florida House Speaker Will Weatherford's outright rejection of Medicaid expansion. My disappointment is matched by my pleasure that Gov. Rick Scott has agreed to the expansion so that millions of Floridians will gain access to care.

Medicaid expansion, as defined by the Affordable Care Act, would insure close to 1.2 million Floridians and cut the uninsured nationally by 48 percent. This would include thousands of low-wage workers in Florida's service industry. Any person — adult, male, childless or otherwise — would be eligible for coverage if they made under $15,000 per year. It cannot be overstated that the effect this has on families is far more than just insuring the individual. Data strongly support that those children with parents who are insured are more likely to remain continuously insured, and that parents with health insurance are better equipped to raise healthier children.

Access to medical services for this population, especially primary care, improves health, reduces emergency room visits and hospitalizations, and thereby reduces costs. More important, by offering access to this care by expanding Medicaid, lives will be saved.

Each month we delay, Florida registers 320 more deaths due to lack of health insurance, 3,000 more lives ruined due to medical bankruptcy and half a million children who will not achieve the success they deserve in life because they continue to live in financially and medically unstable homes.

The argument, pushed by Weatherford and others, that the federal government cannot be trusted to keep its funding commitments to the states, is simply a myth. The federal government has funded its share of Medicaid every year for 48 years since the program's inception.

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Under this expansion of Medicaid, the federal government is paying 100 percent of the cost for the first three years and then drops slowly to cover 90 percent of the cost by 2020. This is close to $20 billion in federal money — our tax dollars — flowing into Florida over 10 years. This investment is estimated to create 65,000 health care-related permanent jobs in Florida and will save Florida $100 million annually because some safety net programs will become less necessary. So, if the argument were simply about jobs and money, why would Florida turn away Medicaid expansion?

Weatherford enjoys speaking out on the risk of big, intrusive government taking away our freedom and prosperity. I often wonder how many of my uninsured patients feel free to prosper under the looming shadow of financial bankruptcy if they fall ill, or how many feel free to enjoy life when they are living on the edge of life and death?

The Comprehensive Primary Care Initiative through the Centers for Medicare and Medicaid Innovation is studying pilots across the country to reach for the Triple Aim. The Triple Aim refers to the concept that through better care for individuals, and better health for populations, we can achieve lower per capita health care costs.

Weatherford and the entire Legislature should listen to the doctors who care for these patients in the direst of circumstances. Unknown and untested plans are not the answer for Florida. They will lead to failure and ruin the effort to provide affordable, high-quality health care to all Floridians. Expanding Medicaid is the right the thing to do, and doctors will continue to fight for the health of all Floridians, including our patients like William.

Dr. Mona V. Mangat, a board-certified allergist and immunologist in St. Petersburg at Bay Area Allergy & Asthma, is a board member of Doctors for America, a national nonprofit organization that advocates for a better health care system where every person has access to high-quality, affordable health care. She wrote this exclusively for the Tampa Bay Times.