Medicaid, Uninsured Patients Suffer 

( published Emergency Medicine News June 2014)


I share Dr. Leap’s frustration at caring for Medicaid patients that are not paying anything for their care. (“Second Opinion: The Toxicity of Medicaid” EM News online 8 April)  I am exasperated when they ask for a prescription for their child’s acetaminophen when Mom or Dad’s shirt pocket or purse bulges with a pack of cigarettes that costs more than Wal-Mart Tylenol. We shall always have such as these.


I am far more frustrated, exasperated and angered that so many more of my patients are abandoned to fend for themselves by our profits-first health care system. These uninsured patients are good Americans, they work hard serving my family at restaurants, at the aforementioned Wal-Mart, fixing our cars. They deserve care.


Yet I know they won’t get it. Once discharged from my ED I know they won’t be able get ongoing care for their hypertension, diabetes, arthritis. They will live shorter, sicker and less happy lives. They deserve better. The Affordable Care Act will cut the number of uninsured by perhaps 50%  at best while leaving in place very high financial barriers to care .


A just published study from JAMA confirms that our system abandons the uninsured and Medicaid patients. 85% of privately insured patients were able to secure a timely appointment with primary care physicians. Only 58% of Medicaid patients were able to see a primary care Doc. Frankly, 58%  follow-up for Medicaid seems substantially higher than what my experience suggests. For those self-pays with limited resources, only 15% were able to get a primary care appointment. ( Rhodes, Kenney, Friedman et. al. “Primary Care Access for New Patients on the Eve of Health Care Reform” JAMA Internal medicine 7 April 2014)


It is OK for some persons to have bigger televisions than others, OK for some to have nicer cars than others. It is not OK for good folks to suffer and die because they are less “successful” economically. Health care is a human right. I am blessed to work in the ED, the one place where ideally we do care for all.


-- Brad Cotton MD, FACEP