With a limited number of pills to combat her chronic lower back pain, Sheryl Redman often faces difficult choices.
“Do I take my one pain pill and muscle relaxer today to be able to sweep and mop the kitchen floor?” she said. “Or do I take it so I can sleep? Or do I take it so I can take my mother to a doctor at Fort Gordon?”
Unlike many of the uninsured in Georgia who don’t qualify for Medicaid, she has qualified for disability and will get Medicare coverage in June.
But all too often for people like Redman, particularly in the South, cost is a barrier to getting care particularly in states with restrictive Medicaid eligibility, a study published Thursday finds.
In correspondence published in the New England Journal of Medicine, the authors looked at the percentage of people who delayed medical care because of the cost by county, which ranged from 6.5 percent in Norfolk, Mass., to 40.6 percent in Hidalgo, Texas. The highest concentration was in states with more restrictive Medicaid eligibility, and was particularly high in the South, the study found.
“Our results suggest stark geographic differences in the prevalence of care delayed because of cost,” the authors noted.
That can have a real health impact, said co-author Dr. Jennifer Haas, a professor at Brigham and Women’s Hospital in Boston and Harvard Medical School.
“There are a lot of studies that have looked at delayed care and have shown that delayed care is associated with all kinds of bad outcomes, particularly for preventable care or preventable conditions, things like heart disease and certain kinds of cancer,” she said.
The study notes that while the U.S. Supreme Court decision last year upheld the Affordable Care Act, it left as optional a key piece that would expand Medicaid eligibility for working adults in most states to 138 percent of the federal poverty level. In Georgia, that would be more than 800,000 people, about 8 percent of the state’s population and 11 percent of the uninsured population, according to the Kaiser Commission on Medicaid and the Uninsured.
But Georgia Gov. Nathan Deal and other Republican governors have opposed the expansion even with the federal government paying 100 percent of the expansion costs for the first three years and no less than 90 percent thereafter.
Deal believes the state can’t afford it, spokesman Brian Robinson said. It “would cost Georgia taxpayers $4.5 billion more over the next 10 years, and the costs would explode after that,” he said in an e-mail. “The taxpayers of Georgia are already footing a massive Medicaid bill. In fact, part of the reason why we’re still having to cut budgets despite revenue increases is because Medicaid mandates are crowding out other priorities.”
The state would be better if the federal government “would simply give Georgia its share of the money and give the state flexibility in how we administer the program,” Robinson said.
A map of where the delayed care is highest is revealing, Haas said.
“People can see that they’re not being well-served and that there are differences with other areas of the country,” she said. As state and health advocates are debating the Medicaid expansion question “we hope that it informs the discussion a little bit and takes some of the politics out of it,” Haas said.
Delaying care due to cost is very familiar to Janice Sherman, chief executive officer of Medical Associates Plus, a federally qualified health center in south Augusta. Though the uninsured can pay a sliding fee scale to be seen for as little as $25, “it’s still a matter of people delaying it because $25 sometimes is swapped for groceries or basic living expenses,” she said. “It’s pretty problematic.”
While Redman relies on the clinic for her care now, she said she still puts off even basic care because it often comes down to whether she can afford the sliding-scale fee.