Opinion | The safety net is fraying: Emergency care in jeopardy across Michigan

Most people hope never to visit an emergency department. But CDC data shows that nearly 140 million Americans annually utilize emergency department care — often during the most vulnerable moments of their lives. It's often taken for granted that emergency departments will always be there for us, but that assumption is increasingly at risk.

Emergency departments are the backbone of our country’s health care safety net.  In Michigan, the numbers are stark: 1 in 5 adult residents rely on Medicaid for their health care.  Among children, that number increases to 2 out of every 5.  Medicaid also covers 38% of all births in the state. Medicaid isn’t a fringe benefit for the few — it’s a critical lifeline for millions. And it’s a key part of the financial foundation for hospitals that serve our most at-risk communities.

But that foundation is crumbling. Hospitals already operate on razor-thin margins, and those margins are getting tighter. A recent study by the Centers for Healthcare Quality and Payment Reform found that six hospitals in Michigan are at imminent risk of closure, while 14 more are at risk of closures over time.  This is 22% of Michigan’s hospitals.

We’re already seeing the fallout from this underfunding. Just 50 miles from my hometown in the Upper Peninsula, the critical access hospital in Ontonagon recently closed. The nearest emergency department is now a 45-mile drive away — nearly an hour in good weather. In a February snowstorm, that delay can mean the difference between life and death.

A recent report by the RAND Corporation confirms what frontline physicians already know: America’s emergency care system is in crisis and emergency departments throughout the country are strained to, or even beyond, their breaking point.

Declining Medicare reimbursements, shrinking insurance payments, and threats to Medicaid funding are converging to further endanger access to emergency care. Currently, 20% of the care provided by emergency departments in the US is uncompensated, comprising an annual price tag of over $5 billion. This is unsustainable. If there are any further cuts to Medicaid, it is possible that 22 Michigan communities could soon be left without a hospital — and without the lifesaving emergency care we all depend on.

And it’s not just patients on Medicaid who stand to lose. When hospitals close, everyone suffers — whether they’re covered by private insurance, Medicare, or Medicaid. The collapse of emergency infrastructure in any region puts pressure on surrounding hospitals, increases wait times, and reduces the overall capacity of our system to respond in times of crisis.

Emergency physicians like me are proud to care for anyone who walks through our doors — 24 hours a day, 7 days a week, 365 days a year. We are required by federal law to treat all comers, regardless of their ability to pay. But we cannot do it alone. We rely on functioning hospitals, adequate funding, and a health care system that values access for all.

If we continue to underfund Medicaid — or treat it as expendable — we risk eroding the structure that holds our emergency care system together. This isn’t just a policy debate. It’s a matter of access to health care. It can become a matter of life and death.

Now is the time to ensure the viability of the emergency medical system in our state.  We should take steps to protect and strengthen the programs that support emergency care — not dismantle them. When your life's on the line, you shouldn’t have to wonder whether help will be there when you need it.

Tell your members of Congress not to cut Medicaid so we can protect the health care safety net in our state, for our friends and neighbors, for our hospitals, and for the safety net that protects all our residents.