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Medicaid Is Lifeline For The Poor

I see the most vulnerable patients in our state: children. More than half a million New Mexicans receive Medicaid, about 336,000 of whom are children. I see every day how Medicaid (is) a lifeline for (our) low-income working families.

While I agree that we do need to find ways to rein in out-of-control medical costs, the proposal Gov. (Susana) Martinez is considering to increase premiums and co-pays for Medicaid recipients would (be disastrous).

The argument behind charging co-payments is that when patients have “skin in the game,” they will use their health coverage more wisely. However, … a wide body of research shows that cost-sharing reduces both unnecessary and necessary doctor’s visits. In some cases, these fees results in people dropping off of Medicaid coverage and becoming uninsured.

I can tell you anecdotally what research studies have shown: that when co-pays are imposed on very poor patients, they will postpone getting needed medical care until their condition is so severe that they have to go to the emergency room. In contrast, a landmark study found that when patients were not saddled with fees and co-pays, the poorest and sickest patients showed improvements in hypertension, vision and dental care.

At the hospital where I practice we see a large number of children with various chronic medical conditions. The parents of these children already face financial obstacles, from taking care of a chronically ill child and needing to take frequent time off of work. Often these children have multiple doctor visits in a week, given that they require the care of many specialists. Requiring these already cash-strapped families to pay out multiple co-payments a week, or even a month, will place undo hardship on people who are barely making ends meet as it is. Even in otherwise healthy children one hospital admission or one illness requiring a few visits to their regular doctor or the ER could mean a lot of money out of pocket. For all of these families the money that goes to a co-payment could mean that money can’t go to put food on the table, gas in the tank to get to work or to part of a rent or mortgage payment.

Parents make split-second decisions every day about their children’s health, and in the case of asthma attacks or blood sugar spikes, those can be life-or-death decisions. I would hate for a parent to hesitate to bring their child in for treatment in those circumstances, for fear that they will have to pay a large fee if the visit is later classified a “nonemergency.”

There is much talk about “personal responsibility” in the discussion of fees and co-pays for Medicaid recipients. But the responsible behavior we should emphasize is getting primary and preventative care so we can reduce unnecessary emergency room visits. … We cannot afford to add another expense at a time when people are depending on the safety net the most.