By Myrtle Russell
(Conversely, 15,600 older adults died prematurely because of state decisions not to expand. (Part 1- appeared in CNC issue 1-13-2022.)
Part 2 – I recently spoke to a 60 year old who suffers with an autoimmune disease that literally eats away at the hands and feet. The patient needs hydrobaric oxygen therapy, a proven, effective form of treatment that is unfortunately not covered by Medicaid. Expansion could be the difference between this patient losing their hands and feet, subsequently landing them in a long term care facility that would cost Medicaid more in two months than it would cost to pay for the therapy.
It could be the difference between eviction and keeping a roof over the head of the person who has to choose between paying healthcare and/or medication costs or paying rent or mortgage; a choice that no Tennessean should have to make at a time when thousands are feeling the economic impact caused by the pandemic and they have no viable safety net to avoid pending homelessness.
Expansion could also mean that countless numbers of young disabled Tennesseans could regain their independence through expanded payment for medical procedures and assistive devices not currently covered by Medicaid. My daughter, a 42 year old nurse who suffered a massive stroke in 2017 is one such individual. The stroke left her with minimal to no functioning in her dominant right hand and arm. In early 2020, her physical and occupational therapists recommended an orthotic device that could restore functioning to her paralyzed right arm and hand, a device first used by veterans with remarkable success. After an evaluation by the company that makes the device and an order from her PCP, a request for approval was submitted to Medicaid. The request was denied. Three appeals were filed and they too were denied. The reason given for the denials was that the device was “experimental,” which made no sense since we had observed a patient in our home town that is using the device that was paid for by his private insurance company. We also submitted documentation of several federal appeals where judges ruled in favor of the patient. This obviously meant nothing to Medicaid who suggested that we continue with the same physical and occupational therapy that has proven to be ineffective, and the costs over the years would add up to more than the cost of the assistive device. This made no sense to us but after three appeals, we are moving on. Expansion could reverse decisions such as this one that deny the patient the opportunity that would lead to more independence and in my daughter’s case likely result in her returning to gainful employment.
And then there is the 40 year old I know who suffered a stroke and heart attack that left them totally paralyzed and unable to speak. This person was placed in a long term care facility after discharge from the hospital with a feeding tube, tracheotomy, and unable to walk. The scary part to this story is that the person never had an MRI because they were obese and unable to fit into the MRI machine. They were told that Medicaid would not pay for them to be transported to a facility that could accommodate them. So in reality, the diagnosis was never confirmed and their treatment plan was based on guess work by providers. Hard to imagine in 2021 in a country that prides itself on its medical advances. Expansion of services could have made a huge difference in this patient’s level of treatment and overall outcome.
There are countless others in this state with similar stories of poor health outcomes that could have been prevented. I understand that the wheels of justice turn ever so slowly but when it comes to justice in healthcare in Tennessee, we haven’t made strides in decades. In reality, one glance at any health statistic points out that things keep getting worse. In the middle of the “Bible Belt,” the good and right thing for legislators to do is to put personal and political agendas aside and take advantage of this opportunity to improve the health of all Tennesseans and make this a healthier state. If the pandemic didn’t point this out, perhaps the folks we chose to represent us are looking into a crystal ball and seeing things that I can’t see. Wonder what it will take to make them change their view.
Myrtle Russell is a retiree and caregiver. Contact her at firstname.lastname@example.org