A Vision for Peace: Affordable Care for All
By Abbe Sudvarg, PEP Board Chair
This article was originally published in the 2014 edition of the Peace Economy News. To receive the 2016 when it’s released later this summer, please sign up here.
I have been the Board Chair for the Peace Economy Project (formally the St. Louis Economic Conversion Project) for over 15 years—a role that has been both an honor and a privilege. Over the years, we’ve had extraordinary Board members and Directors-all passionately committed to creating a more just and peaceful local, national, and world community.
My work with the Peace Economy Project goes hand in hand with my day (and sometimes night) job as a Family Practice physician working in a Federally Qualified Health Center. FQHCs (otherwise known as Community Health Centers) have the stated mission of providing quality health care to patients, regardless of their ability to pay. Community Health Centers are primary care facilities—we provide the highest quality of outpatient services possible, but there are limits to the care we can provide. Some of the limits are a matter of sheer volume—there are more uninsured people than there are doctors, nurse practitioners and nurses in Community Health Centers to fill the needs. Another limitation is the services we can provide—specialty services and critical care are not services available within our walls.
Because of my work as a doctor who takes care of the poor (and often they are the low-paid working poor who provide our services at fast food restaurants and checkout lanes in discount stores) I was thrilled when the Affordable Care Act was passed. Certainly, as a firm proponent of a single-payer system, I feel there are deficits in the law. But, the part of the law that felt most important to me, and the work that I do, is the portion that expands Medicaid. Finally, my hard working low-income patients, when really ill, would have coverage! I have many, many stories of patients who have declined necessary care because they were afraid of the bills that they would accrue. Perhaps my most poignant is that of my patient who was in her 50s, and stayed home for hours with chest pain, until the pain became so unbearable that she just couldn’t stand it any more. She worked hard for a living and owned a small home in St. Louis, but she had no health insurance. She was afraid to go to the hospital—afraid the expense of the Emergency Room visit would cost her her home. A home that she shared with her son, who had a traumatic brain injury from a car accident, and his little girl whom she was helping raise. Now she has health insurance—Medicare—because the delay in her care cost her so much heart muscle that she now is on disability.
One of the greatest tragedies in this story is that any of my patients, with similar circumstances, are no better off today than this patient was four years ago—for two years in a row, the Missouri legislature has closed its sessions without accepting the Medicaid expansion dollars from the Federal government.
By 2022, Missouri will lose about $1.7 billion dollars in Federal revenue that would come with Medicaid expansion, if our state continues to decline to participate. Medicaid expansion would be so valuable to Missouri’s economy that the Missouri Chamber of Commerce and Industry hired none other than retired Sen. Christopher (Kit) Bond to lobby his fellow Republicans in favor of the expansion. Unfortunately, not even a conservative Republican like Senator Bond could talk sense into our Missouri legislature. Consequently, about 300,000 Missourians will remain uninsured—Missourians who are too poor to qualify for the Affordable Care Act private insurance exchanges, and too wealthy to qualify for Medicaid as it currently exists.
According to an exhaustive study prepared by the University of Missouri—Columbia School of Medicine, Medicaid expansion would have brought to the state of Missouri an estimated 24,008 new jobs in 2014, with 22,175 of them sustained through 2020. It is estimated that these new jobs would have produced a labor income (employee compensation) impact of approximately $977 million in 2014 and would continue to produce approximately $992 million in 2020. Health care jobs are jobs that can’t be outsourced or exported—home rehabilitation after a car accident cannot be performed from India or Bangladesh.
So doesn’t the Missouri legislature want new jobs in Missouri? Last year, the Republican State Senate certainly seemed to want to bring new jobs when they passed a tax incentive bill to attract a Boeing 777X jetliner production plant to St. Louis. The tax benefit to Boeing? $1.7 billion dollars of uncollected tax dollars over the next twenty years—about the same amount of revenue that would be gained by the state, in Federal dollars, over the same period of time, if Medicaid were expanded.
I have been the Board Chair of the Peace Economy Project for over 15 years, and a physician for almost 30 years. For me, a peace economy will only come when the health of our citizens is no longer a political battleground, but instead is an assured right for all.
