At 2 a.m., I could hear the monotonic beeping of an IV infusion pump, a sign that it was occluded. I was waiting with my dad in the urgent care clinic at the hospital where I work. My dad, who has a history of metastatic prostate cancer, had bloody stools and abdominal pain for 48 hours. Previously, my mom had dropped him off at another hospital where there was a no-visitor policy. He waited alone for six hours without having any vital signs taken or being checked on. His symptoms remained, but he went home.
A recent study showed that at some hospitals, up to 10 percent of patients left the emergency room without being seen. This is more likely to happen at hospitals that serve lower-income patients on Medicaid. And with continuous coverage coming to an end, millions of Americans are poised to lose Medicaid coverage that they received during the COVID-19 pandemic. The hospitals and clinics that serve communities and are mission-based will be placed under more strain.
The hospital where my dad was waiting for six hours contracts out their emergency medicine staff to a health care firm owned by private equity. The firm has a history of understaffing emergency rooms and maximizing the bottom line. This is happening everywhere in the United States as health care systems continue cutting costs and margins. Now, with Medicaid continuous enrollment ending, millions will be left uninsured.
The Families First Coronavirus Response Act allowed needy families and individuals to keep Medicaid coverage without the need for eligibility redeterminations. This was instrumental during the pandemic as millions of Americans lost their jobs and insurance. Medicaid coverage surged—over 93 million Americans are on Medicaid, compared to 63 million people on Medicare. Over the next year, 15 million people are expected to lose Medicaid coverage, leading to more stress on an already overburdened system.
Hospitals are already feeling the burn. Last year, Atlanta Medical Center closed in Atlanta, leaving Grady Memorial Hospital the only Level 1 trauma center in Atlanta. In Philadelphia, Hahnemann hospital was shuttered after its parent company, for-profit Tenet Healthcare, no longer found it financially feasible.
There are reasons why the United States ranks last in access to care among peer countries. U.S. health care spending in 2021 was $4.3 trillion, which accounted for 18 percent of our gross domestic product. Private equity and venture capital have invested billions into the health care system. Yet, over 100 million Americans are saddled with medical debt.
The Wall Street Journal recently compared the governance of New York to Florida and criticized New York's large Medicaid budget. However, Florida's rate of uninsured individuals is twice as high as New York. Ultimately, the smaller Medicaid budget shifts the onus on the individual, leading to the astronomical amounts of medical debt in the U.S.
People who are uninsured cannot take advantage of Medicaid, and those without insurance avoid seeking medical care, resulting in worse health outcomes. As Don Berwick, former administrator for the Centers for Medicare and Medicaid Services wrote, greed and misaligned incentives are harming our patients and our health.
The truth is that health care is big business, and the primary goal is not necessarily the best patient outcomes. Until the most important incentives are aligned—better quality of life, health outcomes, life expectancy with profits—we'll continue to see this gaming of the health care system.
One fix that could help millions of Americans is the termination of Medicaid "churning," which has been put on hold during the pandemic. This refers to the temporary loss of Medicaid coverage while eligibility is being determined. It is a process that disenrolls millions of eligible Medicaid recipients due to administrative errors and paperwork. Incorrect addresses and contact information, changes in work and employment (especially for those who work jobs without a fixed salary), lead to loss of coverage. The recent increase in Medicaid coverage since 2020 has been, in part, due to the temporary halt of administrative churning.
Another solution would be the expansion of Medicaid in the 10 states that have previously refused. North Carolina, after years of debate, recently expanded their program. Expanding Medicaid eligibility will help to pay for these struggling hospitals, especially rural hospitals, and help to decrease the financial burden on individual states. Additionally, this expansion will help to decrease medical debt. Even though 90 percent of Medicaid expansions will be paid for by the federal government, these states continue to refuse, mainly for political reasons.
When my dad was finally seen at a different hospital (where I worked and could wait with him), he had abdominal imaging done and was diagnosed with diverticulitis. He was sent home with a dose of IV antibiotics and felt better within a few hours. What would have happened if he had stayed at the other hospital, waiting to be seen? It's time for a change. The longer we accept an arrangement that prioritizes profit and financial incentives in our health care system, the more people will suffer for the few in power to make an extra dollar.
Joshua A. Budhu, MD, MS, MPH, is a neuro-oncologist at Memorial Sloan Kettering in New York, and a Public Voices Fellow of AcademyHealth in partnership with TheOpEd Project.
The views expressed in this article are the writer's own.
Uncommon Knowledge
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
