Opinion | They Say They Are Attacking Abortion. They Are Really Hurting the Poor.
For people who live in poverty in America, getting medical care is never easy. In Texas, health care for the poor is particularly challenging: Medicaid rules are among the most stringent in the country. A family of four with two parents must earn less than $285 per month to qualify. And for those who do receive Medicaid, finding a provider can present even greater challenges. It’s about to get worse.
For the past several years, Texas politicians have worked to cut off Medicaid recipients’ access to the wide range of services offered by Planned Parenthood. Now, barring an extension of a state district court’s temporary block on their efforts, they may have gotten their way.
Republican Gov. Greg Abbott and like-minded state officials targeted Planned Parenthood because it offers abortion services. But abortion services account for just a fraction of the care we provide, which means the consequences of a new policy would be far more sweeping.
If it goes into effect, this policy would block patients’ access to blood pressure checks, cancer screenings, birth control, S.T.D. treatment and other medical care routinely provided at Planned Parenthood health centers in Texas, where I serve as a medical director for primary care. Nationally these other essential services, not abortion care, account for 96 percent of Planned Parenthood’s patient visits; in Texas, for example, some 24,000 Medicaid patients received non-abortion care over the past four years.
Already, federal Medicaid funds cannot be used for abortion care. The 1976 Hyde Amendment banned federal funding for abortions, except in cases of life endangerment, rape or incest. But most states allow patients with Medicaid to use their coverage to get other essential care at our health centers.
Republicans in Texas have been trying to cut Planned Parenthood from its Medicaid program for several years. In February 2017, a federal judge temporarily blocked these efforts, but last November, the U.S. Court of Appeals for the Fifth Circuit reversed the lower court’s ruling. A temporary stay of that decision has left our patients in limbo, not knowing whether they will lose access to our services . Though the final decision has been postponed once more due to Texas’ sudden blackout calamity, the concern still looms.
I’ve seen up close patients’ struggles to get medical care and the harms that result from lack of access. A woman I care for stopped taking her medication for hypertension after losing her insurance coverage; her blood pressure spiked to life-threatening levels and rendered her ineligible for a needed surgery.
Another one of my patients needs monthly monitoring for a rare precancerous condition. Until this month, Medicaid covered the cost of her monthly testing with us; under this policy, she would be forced to try to find another doctor.
That’s not as easy as it sounds. Larger cities, like the one where I practice, have plenty of other medical providers. However, Texas’ Medicaid program pays less than most private insurance. Surveyed in 2016, some 55 percent of primary care providers said they would not accept Medicaid patients in their practice. As a result, what should be a straightforward process of finding a new provider is all but impossible for a patient with Medicaid coverage.
When I told my patient that Texas would no longer allow her to use Medicaid to pay for her cancer screenings with us, she was shocked and angry that the medical care she was counting on was suddenly off limits.
One way to avoid this problem would be for Texas to expand Medicaid under the Affordable Care Act. If it did, some 1.4 million uninsured Texans would finally have medical care within reach. Yet Texas, along with 12 other states, still refuses to do so. It would save thousands of lives, primarily in communities of color. Medicaid expansion would also protect low-income Texans from financially catastrophic medical bills after hospitalizations for medical complications — many of which could have been prevented if they had insurance. For example, one of my patients has epilepsy. Because she is uninsured and can’t afford her preventive medications, she continues to have life-threatening seizures that often land her in the hospital.
States’ denials of healthcare coverage, including Texas’ refusal to expand Medicaid, contributed to 461,000 excess deaths in 2018 that would have been averted if the United States had kept up with other wealthy countries, a tragedy documented in a report by my colleagues and me published this month in The Lancet. As we detailed in that paper, Texas’ Medicaid restrictions mirror broader public health failures under the Trump administration, including its handling of the Covid-19 pandemic. We found that the prior administration’s inept response led to Covid-19 death rates that are 40 percent higher than those of other wealthy countries, with the heaviest burden falling on people of color.
Texas isn’t the only state to try to keep public funds from Planned Parenthood — and it’s our poorest patients who suffer as a result. President Biden has vowed to stop states from such nakedly political attacks on health care providers that also offer abortions, such as Planned Parenthood. But short of timely new federal action, I’m worried my Medicaid patients will have lost a critical source of health care after the next hearing on the issue.
Ideologically driven attacks on health care access have extremely harmful real-world consequences. In these difficult times, we need to make medical care more available, not less.
Dr. Samuel Dickman, an internist, is the medical director for primary care at Planned Parenthood South Texas and a member of the Lancet Commission on public policy and health in the Trump era.
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