MIND THE GAP.

melissa_see_wht By Melissa See, MD

4 million people. That is how many Americans currently fall into the “Coverage Gap.” The “Coverage Gap” is a gap that results in states that decide not to expand Medicaid under the 2010 Affordable Care Act (ACA). This means that nationally, there are 4 million poor Americans without health insurance because they make too much to qualify under the traditional Medicaid Program, and at the same time, make too little to be able to take advantage of the tax credits that help individuals afford health coverage through the Marketplace under the ACA. These are the working poor—they are employed, either part-time or full-time, but still living below the poverty line.

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Currently, there are 23 states that have voluntarily chosen not to participate and expand Medicaid eligibility under the ACA, which essentially was created to extend insurance coverage to low-income individuals with incomes at or below 138 percent of poverty ($27,310 for a family of three). Utah is one of those 23 states.

There are various reasons why different states have chosen not to expand Medicaid eligibility under the ACA. So what is it exactly that is keeping the state of Utah from participating? I recently had the opportunity to attend a legislative update hosted by the Salt Lake City Medical Society under the Utah Medical Association. Representative Greg Hughes, Utah Speaker of the House, and Senator Brian Shiozawa, MD, provided this legislative update.

What I learned after hearing these gentlemen speak on ACA, Healthy U, Utah Cares, as well as the “coverage gap”, is that simply, Utah has commitment issues. The Utah 2014 Legislature decided they weren’t quite ready to commit. In going back to the “coverage gap”, as Senator Shiozawa was explaining during this talk, Governor Herbert’s proposal of Healthy U would cover Utahns earning up to 138 percent of the poverty level, $15,521. Healthy U is essentially Utah’s personalized take on the ACA, and will cost just $25 million to start, while creating 3,000 jobs in the state economy. However, Representative Greg Hughes, Utah Speaker of the House, went on to explain that he believes there is just too much uncertainty surrounding the economics of providing coverage. Rather than take any sort of action on the matter, the legislature opted to seek out more time to analyze ways in which the ACA may be detrimental to the health of Utahns, both fiscally and physically. As an alternative, Utah Cares is a rival health proposal to Healthy U that is pushing for the Primary Care Network – a health plan that covers preventive services only, but no emergent or inpatient services, and will cost the state $60-$70 million dollars.  With Utah Cares, the Utah Legislature’s commitment issues leave 90,000 Utahns without any coverage, while pushing for a health plan that covers less, and costs more.

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Dr. See and Senator Shiozawa, MD at the SLCMS-UMA Legislative Update

As Senator Shiozawa closed out his talk on Healthy U he reminded the room full of physicians representing various specialties, that to “do nothing is not an option.” As a future family physician, I believe it is imperative to be mindful and knowledgeable on health policies and proposals being created and decided on. If we do not educate and advocate for our patients, our communities, or our practices, these matters will be left to parties who are inexperienced, out of touch, or worse, afraid to take any action. It is clear to me where I stand on the matter. The views I have presented in this blog post do not represent the views of the University of Utah Department of Family and Preventive Medicine or the University of Utah Family Medicine Residency Program. While I will continue to educate myself on all sides of the matter, I will ultimately always stand on the side of DOING SOMETHING.

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Dr. See and Dr. Leiser at the Utah State Capital for Family Medicine Advocacy Day.

Melissa See is a first year Family Medicine Resident at the University of Utah School of Medicine.

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