published Thursday, February 21st, 2013

Cleaveland: How much is a life worth?

By Clif Cleaveland

Thus far, debate over expansion of TennCare has revolved around costs and political ideology. The plight of human beings -- Tennesseans who have no health insurance -- has not been factored into the discussion.

Twenty-one percent of our state's 6.3 million residents fall below the federal poverty level (FPL). They are eligible for TennCare, our state's Medicaid program. Eighteen percent (1.13 million) are currently enrolled.

An additional 98,000 are eligible for the program but have not enrolled. I can find no explanation for this. Possibly, these persons are unaware of their options or lack access to social services.

TennCare cost $8.5 billion in fiscal year 2010. For every dollar our state spends on TennCare, it receives $1.95 from the federal government.

The Affordable Care Act of 2010 was modified last year in a split decision of the U.S. Supreme Court. A requirement that each state must expand its eligibility for its Medicaid program to include persons earning up to 138 percent of the FPL was struck down. Instead, expansion was made voluntary for each state. Expansion of Medicaid programs would begin in 2014.

Expansion of TennCare to 138 percent of FPL would make an additional 360,000 Tennesseans eligible. Under provisions of the ACA, the federal government would pay all of the costs associated with the expansion for the initial three years. Federal support would be gradually reduced to 90 percent in 2020. Continuing thereafter, the state would pay 10 percent of the costs of the expansion.

Currently, governors of 20 states support expansion; 16 are undecided; 14 oppose expansion. Arkansas is the only Southern state to embrace expansion. Governors of Tennessee, Georgia, Alabama, South Carolina, Virginia and Texas are among the opponents. Governors of Kentucky, West Virginia and North Carolina are in the undecided column.

An estimated 330,000 to 475,000 Tennesseans could qualify by 2019 as newly eligible for TennCare if our General Assembly votes in favor of expansion. Depending upon enrollment, the cost to the state for the first six years of the expanded program could range from $715 million to $1.5 billion.

These are numbers. Let us consider the human dimension.

Failure to expand TennCare eligibility would leave hundreds of thousands of our people vulnerable to illness, injury and financial ruin. In the absence of access to physicians and clinics they would have no option at times of illness or injury but to seek care at an emergency room. By law, emergency rooms cannot turn away uninsured patients. These patients would receive none of the discounts extended to people with health insurance. A large ER bill could tip financially vulnerable people into bankruptcy.

ER care does not assure continuity of care. Who would provide follow-up care for the woman with newly diagnosed diabetes? Or the young man with panic attacks?

Uninsured persons are reluctant to seek care for symptoms until they become severe. A lump may be ignored until the malignancy it heralds has spread. Pap smears in women, prostate exams in men, screenings for breast, colon and skin cancers are postponed because of costs. Chronic illnesses such as emphysema, asthma and high blood pressure go untended. Risk factors for heart disease go unheeded.

Nationally, an estimated 35,000 to 50,000 uninsured people die annually as a consequence of being uninsured. How many Tennesseans will needlessly die if TennCare is not expanded -- 100? 300? 1,000? How much is each life worth?

Expansion of TennCare will save lives. It will ultimately reduce health care costs -- which would otherwise be spread over insured patients -- through prevention and early diagnosis of illnesses and through careful supportive care of those with chronic conditions. Monetarily and morally, expansion of eligibility for TennCare is the proper action for the Tennessee General Assembly.

Contact Clif Cleaveland at cleaveland1000@comcast.net.

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