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Opinion | Medicaid expansion to adults — why wait any longer?

I have lived and worked in rural Alabama as a pediatrician since 1980. I have participated in the expansion of Medicaid for children up to age 19. I am very proud to say that because of Medicaid and the Children’s health Insurance Program now only 2 percent of Alabama’s children are uninsured. Preventive care has increased with excellent immunization rates, access to dental care and a substantial drop in teen pregnancies as well as many other healthy changes for our children.  I have witnessed the vast improvements in the care of maternity patients.

Since I have worked in the same community for all of my career, I have watched my patients turn 19 and struggle to afford health care especially medications. In fact, the largest number of uninsured are young adults including women during the child-bearing years. There are several consequences of these patients losing Medicaid.  The ones with chronic illnesses try very hard to be classified as disabled primarily so they can still qualify for health insurance.   Patients with sickle cell disease, asthma, congenital heart disease, chronic depression or anxiety disorders, hypertension, epilepsy, or diabetes often lose their desire to become productive adults once they are classified as “disabled.”  Women who have no health insurance go untreated for these chronic diseases until they are pregnant. Their pregnancy starts as high risk. Usually it’s the second trimester of pregnancy when 50 percent of women once again qualify for Medicaid. Six weeks after the delivery of a child, they once again are without care. We now have the highest infant mortality in the nation probably because we do not care for our young women appropriately.

Rural hospitals have been especially hard hit trying to care for patients without insurance and a prematurely aging population. My local hospital is now, like so many other rural hospitals, operating in the red. We have a very busy emergency room and are on the front line for stabilizing very sick patients. We also have an on-going increase of mentally ill patients with nowhere to send them quickly other than the local jail.

Mental Health services are sorely limited in our state. Most mentally patients are too old for Medicaid and too young for Medicare. Medicaid expansion to adults under 140% of the poverty level may well be the shot-in-the rem to save our Mental Health Programs and our Rural Hospitals.

When I read the obituaries in our local paper I am shocked to see that most are for people much younger than I. Rural citizens unfortunately have a shorter life-span because of on-going untreated chronic health problems. Diabetes, hypertension, mental illnesses, can be treated or sometimes even prevented with access to care.

In summary: Provide health care for women before they become pregnant. Support our floundering mental health services—prevent incarceration and overdose fatalities. Don’t let another rural hospital close.

Expand Medicaid.

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Dr. Marsha Raulerson is a pediatrician in Brewton, Alabama and is affiliated with D. W. McMillan Memorial Hospital. She received her medical degree from University of Florida College of Medicine and has been in practice for more than 20 years. She is one of 4 doctors at D. W. McMillan Memorial Hospital who specialize in Pediatrics. Her many awards include: AOA Honor Medical Society, Master Pediatrician, Alabama, Ray Helfer, MD National Award for Child Abuse Prevention, Calvin C.J. Sia Community Pediatrics Medical Home Leadership and Advocacy Award for the AAP, The Ira L. Myers Service Award for distinguished service to medicine and humanity MASA, Child Advocate of the Year by Contemporary Pediatrics, Elizabeth Jenice Riley Memorial Award for Service to Alabama’s Children, Hettie Butler Terry Community Service Award University of Alabama Alumni Association, Embrace Family Award(Children’s Mental Health) for Alabama and the first recipient of the AAP Rushton Award for Community Access to Child Health.

 

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