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Arizona's Medicaid cuts leave some patients with few other choices
Dr. Thomas Hoffeld, chief of staff at the Spanish Peaks Health Center, speaks with a patient covered by Medicaid on August 5, 2009 in Walsenburg, Colo.
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Steve Chiotakis: The state of Arizona's hoping to save at least half a billion dollars by freezing enrollment in some Medicaid programs. One of those programs covers nearly 6,000 people with serious medical conditions.
Reporter Paul Atkinson wraps up a two part series on those Medicaid cuts, and has the story of
one Arizona couple whose Medicaid coverage ends this week.
Paul Atkinson: June Nelson sits behind several thick binders of medical bills. They document her breast cancer and back problems and the glaucoma, diabetes and heart attacks of her husband Bill.
June Nelson: I've had to do this to keep track of all the doctors' bills because Bill has so many doctors.
He's had two hearts attacks and needed 22 stents implanted to carry blood to his heart. The medical costs wiped out the couple's savings.
Bill Nelson: We were no longer able to afford our private insurance, and we had to ask the state for assistance.
The Nelsons are too young for Medicare: Bill's 60, June is 58. But two years ago, they qualified for a state-run Medicaid program. It's for people without insurance who have catastrophic or chronic medical conditions that bring their income below 40 percent of the poverty level.
Nora Nunez: This medical expense deduction program is something that was a godsend.
Nora Nunez is an attorney with Community Legal Services. She's helping the Nelsons after Arizona policymakers froze enrollment in the program to help balance the state budget. It cost Arizona $82 million a year. The Nelsons' coverage ends Sunday and they can't re-enroll.
Nunez: There is nothing they can do right now. I am still trying to find options for them.
One alternative is enrolling in a federal program for people with pre-existing conditions. But there's a catch: enrollees must wait six months after their current insurance ends.
Nunez: I was hoping that there would be an exception for people who clearly cannot afford to wait six months. But that is not the case.
Bill may not be able to wait that long. He's needed stent replacements every six months. His last was in early June. That means he may need a replacement before the federal insurance kicks in.
June Nelson: It's scary. It's very, very scary. We just don't know where we're going to go with this.
There's always the emergency room. But the Nelsons are still paying off emergency room bills from years earlier.
In Phoenix, I'm Paul Atkinson for Marketplace.
As an HIV physician in Arizona, the situation your story hits on is even more poignant when taking care of unmarried patients with AIDS. Even when some of these people try to work their way out of poverty, they exceed the income cut-off for Medicaid, only to have their safety net pulled from underneath them and they subsequently fall back into illness, costing the healthcare system even more. A classic case of "penny-wise, pound-foolish."
Yes I do have 22 stents they are placed end to end in the LAD, RCA, and LCA also they are triple and quad stacked. They are not replaced they are continued to open up the artery and/or stacked inside an old stent. Phoenix Heart is the cardiologist office and I am happy to have modern medicine to help keep me going.
I feel bad for this couple, and I share the belief that no one should face financial ruin because of health care costs. However, as a physician, I need to point out some holes in the story as reported. First of all, it's not possible to place 22 stents in the heart. They simply wouldn't fit. In fact, it would be difficult to fit 22 stents into a single patient even if you stented every blood vessel in his or her body. Also: once placed, vascular stents can't be removed, much less replaced "every six months." It's obvious that Mr. Nelson has a serious health problem, but perhaps one of the biggest complicating factors is that he and his doctors are not communicating very well about exactly what's going on.
