Why expanding Medicaid is so important for young adults with chronic illness.
I am a pediatrician who sees primarily adolescents and young adults. 85% of my patients are on Medicaid. One important aspect of our clinic is that we prepare youth to enter adulthood and enter the adult health care system. We train adolescents and young adults to manage their chronic health conditions independently, with guidance and support from their parents. When they are ready, we transfer them to adult providers, both primary care providers and specialists.
However, there is one huge problem. Unless the young adult is disabled, he or she will lose Medicaid at 19 or 20 years of age. It does not matter if he has had cancer and must take medicines to prevent a recurrence. It does not matter if he has Type 1 diabetes and has thousands of dollars in medication expense. It does not matter if he or she has a seizure disorder, which is kept under control with expensive anti-seizure medicines. He or she will lose their insurance and lose access to live saving medical care and medications. They cannot go onto their parents’ insurance because the parents are poor and have only Medicaid. They cannot go on Healthcare.gov, because they are too poor, that’s right too poor, to qualify for subsidies.
One of my patients is a young man with a seizure disorder. He was diagnosed at 17 and has a seizure type that will require life-long medication so that he can function—go to school, get a job, drive, have a family. At 19 he lost Medicaid. A month later his medication ran out and he could not afford to buy it without insurance. Predictably, he had another seizure and had to go to the emergency room and was hospitalized for a few days. The cost of the ER visit and hospitalization was more than the care he would have received for decades, not to mention the trauma he and his parents experienced waiting for and then experiencing the recurrence of his seizure disorder.
I had another patient with Type 1 diabetes. We enrolled him in a Medication Assistance Program so that he could continue to get insulin and supplies when his Medicaid was cancelled. However, we could not get assistance for him to continue seeing an Endocrinologist, a specialist that treats Type 1 Diabetes, and he fell out of care. Diabetes is a condition that requires ongoing monitoring and adjustment of medications. Without access to a doctor to help him adjust his medication he slowly drifted into diabetic ketoacidosis or DKA, a condition that occurs when inadequate insulin is consistently administered to a person with Type 1 Diabetes. He almost died. He was in the hospital over 1 week and in the ICU 2 days. The cost of that hospitalization would have paid for specialty care for many, many years. All but 12 states have expanded Medicaid. Virginia, Kentucky, Oklahoma and many other very conservative states have passed Medicaid Expansion. 90% of the cost is covered by the federal government. By not expanding Medicaid, Tennesseans are paying federal taxes that support Medicaid Expansion in 38 other states but not their own citizens. As a physician taking care of young adults with chronic disease, I think it immoral and unethical that the Tennessee legislature has not expanded Medicaid. For the sake of my patients and all Tennesseans I hope they do expand Medicaid and soon.
