Uninsured watch anxiously as Medicaid debate rolls on

Greg Hunt does not consider himself a gambler.

But, in the back of his mind, the 25-year-old Kent County resident knows he is one health crisis removed from thousands of dollars in medical bills he can't pay.  Given that he has Addison's disease, a chronic endocrine disorder, an overactive thyroid gland and diabetes, it's more than an idle concern.

Hunt works up to 33 hours a week at $8.05 an hour at an area gas station. As a part-time employee, he does not qualify for health insurance. He makes just enough to pay rent, buy groceries and put gas in a car he borrows from his stepfather. He's also taking courses which he hopes lead to a nursing degree from Davenport University.

So, like many other twentysomethings, he forgoes health care insurance he cannot afford and hopes for the best.

“There's only so many things you can control,” he said.

There are thousands like Hunt in Michigan, their health care fate in the balance as legislators wrangle over Gov. Rick Snyder's proposal to expand Medicaid coverage. Snyder's plan to add an estimated 470,000 uninsured low-income individuals to Medicaid by 2021 stalled last month in the face of conservative resistance in the Republican Legislature.

This week, though, focus turned to a revised plan that cleared the House Michigan Competitiveness Committee on Wednesday. Under it, those earning between 100 percent and 133 percent of the federal poverty level could either purchase private insurance through the insurance health exchange authorized by the federal Affordable Care Act or pay up to 7 percent of income on out-of-pocket medical expenses under Medicaid coverage.

Advocates say failure to enact expansion would do more than undermine medical care for the uninsured, but also assure that Michigan hospitals will rack up more unpaid bills -- costs that are ultimately passed on through higher charges and escalating insurance premiums.

“The Medicaid expansion is a very smart way to go,” said Laura Appel, vice president of federal policy and advocacy for the Michigan Health and Hospital Association.

She noted that MHA figures show that in 2011 Michigan hospitals furnished nearly $1.9 billion in uncompensated care. Expanded Medicaid, while not a panacea, “will help alleviate that,” she said.


Appel also argued that it also would lead to better health care, by promoting preventative medical practice and regular contact between patients and physicians and other health-care providers.

“You are ultimately going to have better outcomes,” she said.

Evidence for that, however, remains in dispute. A study released in May by the New England Journal of Medicine found mixed results in a comparison of a group of Oregon residents covered by Medicaid and a comparable group that was uninsured. It found that expanding Medicaid coverage “generated no significant improvements” in a variety of physical health outcomes. It did find a reduction in cases of depression and greater financial security among those on Medicaid.

Who will be affected by Medicaid expansion?

There are nearly 1.2 million uninsured residents in Michigan, according to a 2013 analysis by the Michigan Department of Community Health. Wayne County led with 277,663 residents, followed by Oakland County with 117,460, Macomb County with 96,541 and Kent County with 73,099.

Snyder frames expansion as a prudent reform to the health-care system that would save money for both the state and health care providers. He projected general fund savings of $206 million in 2014 and $1.2 billion in savings through 2020. The savings stem from patients who now receive mental health services paid by state general funds. These patients would be covered under Medicaid expansion.

MORE COVERAGE: Michigan gets high marks for private management of Medicaid

Under terms of the Affordable Care Act, the federal government is committed to pay full cost of Medicaid expansion from 2014 through 2016. Its share would fall to 90 percent by 2020 with states to pay no more than 10 percent after that.

Snyder proposes banking half of projected general fund savings to compensate for added state costs that accumulate after 2016. An analysis by the Senate Fiscal Agency projects that a “crossover point” - where costs exceed savings – will occur anywhere from fiscal year 2023 to FY2036.

Who’s on Medicaid now?

According to the state, Medicaid covered about 1.8 million residents, as of  April,  including nearly 1 million children, 287,298 disabled and 108,672 elderly.

Though more than half of total recipients, children accounted for just 25 percent of total cost as of fiscal 2012. Disabled adults accounted for 39 percent of cost, aged residents 19 percent and parents and caretaker adults 15 percent.

Medicaid’s total cost in Michigan in FY2012 was $12.9 billion, including $8.5 billion in federal funds and $2.4 billion in state general funds and general purpose funds, reports the Department of Community Health.

The expanded pool of Medicaid recipients would encompass low-income, able-bodied parents and adults who have no children and earn up to 133 percent of the federal poverty level. Medicaid now covers individuals  making up to $4,020 annually and families of four up to $8,713 annually.

Medicaid expansion was a key piece to health-care reform passed by Congress in 2010, projected to add 17 million U.S. residents to its health-care umbrella. But the U.S. Supreme Court in 2012, in upholding most of  the act, struck down its mandate to expand Medicaid. It left that decision to states.

Since then, about two dozen states have either rejected expansion or are leaning against it.

The costs of the uninsured

While he would welcome the health security expanded Medicaid could offer him, Grand Rapids resident Hunt said he hopes to have coverage of his own within four years.

“Maybe you will have a better job,” he said.

But until then, he is at the mercy of events beyond his control. He recalled his hospitalization in December at Metro Health Hospital in suburban Grand Rapids for a diabetic attack.

“It ran me $12,000. They wrote off that bill,” he said.

Hunt said he owes about $515 on another hospital bill that he is still paying off. He has a prescription to regulate his thyroid gland that he can't afford to fill.

“It costs $100 a month. I can't afford it so I don't get that one,” he said.

A Grand Rapids physician who treats both the uninsured and those on Medicaid said choices like that, forced by lack of coverage, can be costly.

“A patient I can think of ended up having a stroke,” recalled Thomas Platt, chief medical officer for Cherry Street Health Services, a West Michigan nonprofit offering comprehensive health services to low-income children and families.

“Had that patient been able to get in for the right medication and services, that was a totally preventable situation. There was a very good chance that stroke never would have happened. It's a big issue. Patients say, 'Do I get food, do I pay my rent or do I pay for my medication?'”

Platt cited another patient with a painful foot condition whose lack of coverage jeopardizes both her health and job:

“She has plantar fasciitis and no medical coverage. The surgery to correct this is about $4,500. I am afraid she is going to lose her job because she is walking on a hard surface all day. There is simply no other way of getting that corrected.”

Grand Rapids residents Aurelio and Maria Salto make about $26,000 a year in joint income, from his work as a carpet installer and her home business selling kitchen ware. With a daughter, Elizabeth, 18, they are near the income cutoff for expanded Medicaid. The Saltos say they cannot afford health insurance.

And with virtually no savings, the Saltos think twice before seeing a doctor. They are still paying off part of a $2,400 medical bill Maria, 53, incurred from a lifting accident at an earlier job in a factory. Aurelio, 44, recalled that he underwent a recent physical exam and was told to get follow-up blood and other tests. He deferred.

Speaking in Spanish, with his wife translating, Aurelio said, “I didn't go because I knew it would be a bigger bill.”

Ted Roelofs worked for the Grand Rapids Press for 30 years, where he covered everything from politics to social services to military affairs. He has earned numerous awards, including for work in Albania during the 1999 Kosovo refugee crisis.

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Big D
Thu, 06/13/2013 - 8:35am
This is the typical liberal attitude: "Here's someone who is in distress and needs our help"...the government, of course. Its particularly obnoxious when the poster-person is fake (not saying that's the case here). Versus: Let's get on board and support a massive federal take-over of 20% of the economy, limiting personal freedom, exacerbating the fiscal crisis, perpetuating the divisiveness they love, and continuing to destroy the Republic by seducing the states into fealty with money taxed from their citizens in the first place.
Jim C
Thu, 06/13/2013 - 10:39am
I'd say a typical liberal attitude is more along the lines of, "Every first world Democracy besides America has some sort of cheaper, government-run healthcare system - why wouldn't we want that?"
Thu, 06/13/2013 - 11:48am
If we expand the health system to bring in 1.2 million uninsured and encourage them to practice preventative medicine, then we must change some of the existing laws to allow more of the things that are presently done by doctors to be done by physician assistants and nurses. There simply are not enough general doctors in the field today. Maybe it's the way they are paid that causes doctors to go toward the specialty fields other than family practice, maybe it's something else. But whatever, we need to make the system work with the increased patient population. I already have friends who have been told by their doctors that when Obamacare happens, that they will no longer be seeing medicare patients, and medicare pays better than medicaid.
Fri, 06/14/2013 - 12:13pm
Did anybody else notice that guys Zelda shirt? That's so cool
Fri, 06/14/2013 - 1:50pm
Greg can get a thyroid pill over the counter Iodoral 12.5 Mg or 50 mg for much less than $ 100. It is better quality than Synthroid. Amazon has it. What dose did the doctor prescribe? Alternative medicine works.
Fri, 06/14/2013 - 2:11pm
Does Greg qualify for Medicaid under the assets limit? What is the limit-having assets valued less than $ 2,000?
Thu, 12/12/2013 - 3:44am
I was diagnosed with Addison's disease twenty years ago, at the age of sixteen. I graduated high school in '93 with a 3.86 GPA and a ACT score of 29, and entered college at the age of seventeen, prepared for a very successful life. However, at eighteen I was removed from Michigan's Crippled Children's Fund due to my age, and did not qualify under my parents' health plans. For a few years I hung on, finishing nearly three years of undergrad studies and working at least 30 hours a week on top of that, but eventually the fact that I could not see an endocronologist for my Addison's, nor a regular doctor for things like a broken wrist, bronchitis and so on caused me to lose steam. I dropped out of school and started working part time, moving back with my parents. Chronic hyponatremia (low salt) due to not taking the right amount of Corticosteroid caused me to vomit often and faint due to dehydration. My heart rhythms were disturbed by the severe hypokalemia (low potassium) I suffered, again from my steroids being too low (couldn't afford refills often so took one every 2-4 days. I was in the ER probably 5-6 times every year from 1993 - 2013 with Addisonian crises. My ER docs would say call your endo, I would explain I was uninsured, I wasn't working enough to pay the fees of visits and I was turned down eight times in my quest for Medicaid and disability. I finally got disability SSD and SSI in April, 2013, and health care for the first time in a decade. I was hospitalised for nearly two months and have had three surgeries as my doctors uncover the raveges that the lack of routine care has caused. My doctors can't believe the condition I was in and one who had worked for Doctors without Borders said he wasn't aware things like this happened in any Western country. Because the cause for my Addison's was never treated I have developed many other auto-immune disorders, sarcoidosis and hypothyrodism, to list just a few. My hair falls out in clumps from lack of minerals and vitamins. I have difficulty walking and breathing on bad days, trouble swallowing solid foods and spend a full time work schedule in doctor's offices and hospitals, all due to a lack of routine care. Instead of becoming a productive member of society who is able to contribute, join the Peace Corps as I once dreamed and give back to society, I will be on disability, a dependent for life. Considering that every other civilized country in the West has universal health care and considers this a human right, I really think we need to take that step and make a decent life for all Americans.
Fri, 03/06/2015 - 1:18pm
My husband has multiple problems, Post kidney transplant, triple bypass and 11 heart stents, he went back to work full time after each of these. But in 2012 he slipped on the ice at work, hit his head and developed a traumatic brain injury. He is currently on workers comp. he had no other medical coverage than what he received for his head injury. Without his workman's comp, I did not make enough to go through the Federal health plans, ( I have medical issues too), they recommended Medicaid, but Medicaid included his workers comp and we made 400 per year too much. After rent, bills, gas, food & medications there is no money left over! In October Michigan medicaid changed and no longer counted the workman's comp as it is untaxable. So we applied. No problem with mine but nothing but a nightmare with his. He has Medicare A left over from his kidney transplant, it only covers inpatient hospitalizations. We reported this when we applied to Medicaid. He was given a medical card and told he would have straight medicaid. But when he went to get prescriptions it was denied as they said he had medicare D, so we cash for his prescriptions, as we had been doing. I was able to get some free from Meijers and The drug companies drug assistance programs, and shopped around for the lowest prices. But we believed he had straight medicaid, so finally to the Drs he went, he went to a university hospital to get some oral work he desperately needed done on an out patient bases every time using his medicaid card, verified each time by registration. Then we start getting calls Medicaid will not pay the bills because they feel his medicare B should pay, He has no medicare B, so 2 weeks it takes to get a hold of the worker, she says nothing she can do, call the medicaid hotline, so we do. They tell us he was put into a healthy plan, but shouldn't be because anyone with any type of medicare is not allowed in the Healthy plans, get a hold of your worker. 2 more weeks of daily phone calls and we get a call back from the worker, she said she put him into an Add On plan under the umbrella, but she kept using the words medicare. So we will wait, it doesn't start till the 14th, she doesn't think it will cover his back Drs or outpatient bills he acquired with his Medicaid card, I am in tears, I suffer from clinical depression, this only makes it worse. Are they forcing him off medicaid onto medicare, which will mess with his workers comp payments during transition, we will lose our home, we live pay check to paycheck, so depressed!