Rob: Now, you kind of
danced around that a little bit. Not exactly, but are you uncomfortable saying
it, that if a governor decides not to implement this policy people will die?
That your study suggests strongly that people will die?
Dr.
Sommers: Our studies
certainly suggest that it--I think one of the things I'd say you have to be
careful about is, like I said, states are different, you know very different
policies and if a state said, "No," to the Medicaid expansion but found another
way to get coverage to this many people or found another way to improve health
care access for this many people, it might that it could be effective.
Unfortunately,
my suspicion is that states that are not going to do the Medicaid expansion are
probably not going to be able to afford to do another major change to their
health care system, because the Medicaid expansion is so heavily funded by the
federal government and most state budgets right now can't really afford to do
anything on their own.
So, you
do hear a little hesitation in my voice which is to say definitively there's
going to be people dying in these states is a--that's suggested by our findings
but I always do try to take the broader context in mind that there are others
factors that would affect how the health of the population would be impacted.
But certainly I would agree with the statement that expanding Medicaid seems to
both improve access and health and even survival for long term adults.
Rob: Now, what are those
other factors?
Dr.
Sommers: So, one of the big
factors that can vary quite a bit across states is, "What happens to people who
don't have health insurance? Is there any kind of safety net pool in place that
some states have set aside funds for? Are there federally qualified health
centers that are pledged to taking care of patients without health insurance,
regardless of their ability to pay? Or are people really more left to the charity
of individual providers and if they can't find someone willing to treat them,
often will delay care until the last possible minute when it's sometimes too
late to really help?"
Rob: So, what are some of
the states that are talking about not taking this program? One of them is
Texas. What are some other ones? Florida?
Dr.
Sommers: The governor of
Florida has suggested it that Florida probably won't participate. Louisiana,
Wisconsin, South Carolina have all had statements from the governor's office
suggesting that they are probably not going to implement the Medicaid
expansion.
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