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Friday, April 1, 2011


Erin Kelly

Staff Writer

In a dramatic headline in the op-ed section of the Wall Street Journal, Dr. Scott Gottlieb brazenly tells the reader that being covered by Medicaid "is worse than no coverage at all."

Unfortunately for readers, the research Dr. Gottlieb cites does not tell the whole story about Medicaid coverage and his claim that having no coverage is better than being covered by Medicaid is absurd.

Medicaid is a program designed to help the most vulnerable in our communities. It is a lifeline for more than 50 million Americans including senior citizens, people with serious chronic health problems or disabilities, and children who would otherwise be unable to afford coverage and would likely go without care when they become sick. According to a study by the Institute of Medicine and other studies, tens of thousands of people die every year because they do not have insurance.

But Dr. Gottlieb fails to mention that. In fact, he completely ignores why Medicaid is needed for America's most vulnerable populations.

The benefits of insuring Americans through Medicaid are obvious. When people have coverage, they are less likely to skip a trip to the doctor when they have a lump in their breast or are having trouble breathing. They're more likely to seek out preventive care, such as screening for diabetes, vaccines, and mammograms, because a visit to the doctor isn't going to push them into debt. And they're more likely to go to the doctor when they first get sick, rather than waiting until their situation deteriorates and they are sicker and need more expensive care.

The recession has helped serve as an important lesson in health coverage. Millions of Americans were laid off and saw their insurance coverage disappear along with their income. Additionally, many employers decided to stop offering insurance coverage in order to save money. Many Americans learned what it's like to be uninsured the hard way. Families across the county had to make difficult spending choices: Would they save for the children's college tuition or would they buy insurance? And for any American with a health condition who is at risk of being denied coverage in the individual market, the choice isn't really up to them.

The research studies cited by Dr. Gottlieb do not tell the whole story. Unfortunately, many people who gain Medicaid coverage arrive with multiple and more complicated health problems. Imagine a woman who loses her job and her insurance coverage. With the loss of income, she struggles to pay her mortgage, keep the utility bills paid, and buy groceries—she can't afford to see a doctor about the lump she finds under her arm. When she does enter Medicaid, it is not unlikely that her lymph node cancer has spread. Does this mean that the doctor who treats her cancer does not provide the same quality of care to a Medicaid patient than she does to her other patients? No. Does the hospital provide less quality care because she is on Medicaid? No. The reality is that many Medicaid patients are sicker when they enter – and this can make a difference in treatment outcomes.

It's clear that Dr. Gottlieb doesn't understand the underlying problems that come when patients go without medical care for too long. And it's even clearer that he doesn't understand how much of a lifeline the Medicaid program is for those who have no other choice.