Most doctors (other than chiropractors and orthopedic doctors) will not see uninsured patients even if they sign a letter of protection that promises payment when the case is settled. This is most likely due to the fact that cases often settle for less than the amount of the medical bills and doctors do not get paid the full amount after the case settles. In addition, some cases take 3-4 years to settle and most doctors don’t want to wait that long to be paid. Our office is forced to turn down numerous cases because the accident victims have no health insurance and very few assets and there is no one with deep pockets to sue.

According to a new study by The Commonwealth Fund, there are more than 15 million uninsured or underinsured people living below the poverty level in the states that have refused to expand Medicaid under The Affordable Care Act aka Obamacare. According to this study, many of these states have very high rates of uninsured or underinsured people.¹ In Texas, the largest state opting out of Medicaid expansion, more than two million very poor people who would otherwise have been insured will remain uninsured. Florida, Idaho, Montana, Mississippi, Louisiana, Wyoming, Georgia and North Carolina also rank near the top of the list of uninsured or underinsured Americans.

Nearly 45,000 annual deaths are associated with lack of health insurance, according to a study published in September, 2009 by the American Journal of Public Health. That figure is about two and a half times higher than an estimate from the Institute of Medicine in 2002. The study, conducted at Harvard Medical School and Cambridge Health Alliance, found that uninsured, working-age people have a 40% higher risk of death than people with health insurance. The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention, assessed death rates after taking into account education, income, and many other factors, including smoking, drinking, and obesity, and estimated that lack of health insurance causes 44,789 excess deaths annually.  The study also estimated that as many as 17,000 people will die directly as a result of their states refusing to expand Medicaid. In Florida, that translates to about six deaths every day.

Although Florida Governor Rick Scott initially indicated that he was in favor of accepting the funds for expansion, he has changed his position on this issue. Florida rejected $51 billion dollars from the federal government over the period of a decade to overhaul its Medicaid program to include people who work, but do not make enough money to qualify for the Affordable Care Act’s subsidies because they earn less than the poverty level. People who earn less than the federal poverty level will be harmed by the Affordable Care Act, which cuts disproportionate share funding to safety net hospitals, reducing the resources available to care for the remaining uninsured.

Steffie Wollhandler, study co-author, professor of medicine at Harvard Medical School, and a primary care physician at Cambridge Health Alliance, noted: “Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives.”

According to an article by Billy Manes called “The perils of Florida’s refusal to expand Medicaid,” an estimated 2,000 people are expected to face dire health issues due to lack of access to care.² On March 21, 2014, Charlene Dill was supposed to bring her three children to the home of her best friend, Kathleen Voss Woolrich. These two women helped each other, forming a safety net where one did not exist. When Dill never showed up with her three kids, Woolrich sent Dill a text message – something along the lines of “Thanks for ditching me, LOL” – not knowing what had actually happened. Dill had a job selling vacuums on a commission basis for Rainbow Vacuums. On that day, she made two last-minute appointments. At one of those appointments, in Kissimmee, she collapsed and died on a stranger’s floor.

Dill had a documented heart condition for which she took medication. Under the Affordable Care Act, Medicaid plays a key role in efforts to reduce the number of uninsured by expanding eligibility to nearly all low income adults with incomes at or below 133% of the federal poverty level. She was one of the people who fall into the gap created by the 2012 U.S. Supreme Court ruling that allowed states to opt out of Medicaid expansion, which was a key part of the Affordable Care Act’s intention to make health care available to all U.S. citizens, regardless of their income.

The Consequences of Opting Out of Medicaid Expansion

The Supreme Court’s decision to allow states to opt out of Medicaid expansion will have adverse health and financial consequences. All low-income adults will face a greater likelihood of depression, catastrophic medical expenses, and death. Disparities in access to care based on state of residence will increase. Without Medicaid expansion, only people who make 100% of the poverty level or more can buy Obamacare, which leaves approximately 800,000 to 1.1 million Floridians without any medical insurance.

In the Affordable Care Act, the federal government offered to take on the cost for states to expand Medicaid – all of the cost through 2016 and at least 90% in later years – to the uninsured who earn up to 133% of the poverty level. Since Florida turned down the $51 billion dollars that could have closed the coverage gap, everyone who pays for insurance will be stuck with higher premiums to help cover the medical expenses of those who don’t have coverage. In addition, Florida has failed to capitalize on the opportunity to create thousands of jobs to care for the newly insured.

There are two important things that the United States federal government can do to make health insurance affordable for all U.S. citizens, as follows:

1. Make smoking cigarettes illegal

The Centers for Disease Control and Prevention say that approximately 443,000 people a year die because of cigarette use. Smoking is not considered a pre-existing health condition under Obamacare. As part of the negotiations to get coverage for those with preexisting conditions, insurance companies received the right to impose premium costs on smokers that are 50% higher than the same plan for non-smokers. Smokers are high-risk patients who need more care than non-smokers do. The huge premiums are a legal way to encourage smokers to quit. Insured people who continue to smoke put a financial strain on the entire healthcare system.

If smoking were illegal, everyone would gain — the insured, the healthcare providers and the healthcare insurers. Unlike marijuana, cigarettes have no medicinal value and will definitely harm a person’s health. Millions of Americans have given up smoking tobacco products, which is not good news to the powerful tobacco lobby. A turn-of-the-century grandfather clause in U.S. tobacco law allows 400 to 6,000 additional chemicals to be added. Additions since then to the average tobacco cigarette are unknown and cigarette companies are under no obligation to reveal this information.

Tobacco use is the single most preventable cause of disease, disability, and death in the United States. Despite the risks, approximately 46.6 million U.S. adults smoke cigarettes. Smokeless tobacco, cigars, and pipes also have deadly consequences, including lung, larynx, esophageal, and oral cancers. The harmful effects of smoking do not end with the smoker. An estimated 88 million nonsmoking Americans, including 54% of children aged 3–11 years, are exposed to secondhand smoke. Even brief exposure can be dangerous because nonsmokers inhale many of the same poisons in cigarette smoke as smokers.

Secondhand smoke exposure causes serious diseases and death, including heart disease and lung cancer in nonsmoking adults, sudden infant death syndrome, acute respiratory infections, ear problems, and more frequent and severe asthma attacks in children. Each year, primarily because of exposure to secondhand smoke, an estimated 3,000 nonsmoking Americans die of lung cancer, more than 46,000 die of heart disease, and about 150,000–300,000 children younger than 18 months have lower respiratory tract infections. An estimated 3,000 lung cancer deaths and 46,000 heart disease deaths are attributed to exposure to secondhand smoke. It is much more important to keep Americans healthy than to keep the cigarette companies in business, especially since secondhand smoke is so dangerous to nonsmokers. According to the 2006 U.S. Surgeon General’s report The Health Consequences of Involuntary Exposure to Tobacco Smoke, there is no risk-free level of exposure to secondhand smoke. Both the Surgeon General and the Institute of Medicine have concluded that eliminating smoking from all indoor areas is the only way to fully protect people from exposure.

2. Overturn the federal law that makes recreational use of marijuana by adults illegal

Only naturally grown marijuana should be legal, not the synthetic variety. There are no non-harmful strains of synthetic marijuana. Some strains are extremely dangerous and deadly. According to an article in the Huffington Post posted on 09/11/2013, synthetic marijuana’s non-cannabis herbs sprayed with lab-created chemicals which are said to give users a stronger high than THC can lead to seizures, hallucinations and convulsions as well as profoundly negative psychological effects. Many people have had to go to the emergency room after ingesting this synthetic drug, which is not medicinal like naturally grown marijuana. The symptoms of synthetic marijuana include vomiting, nausea, accelerated heart rate, and kidney damage.

As Colorado reports the tax revenue from marijuana, many states are very jealous. In January, Colorado received $2 million in tax dollars from recreational marijuana and $3.5 million in marijuana related taxes. Summer is expected to be even bigger, with tourists arriving to be able smoke marijuana legally. At this rate they could reap $40 million for the year. The initial money is to be spent for school construction; after that the state has yet to decide. It is no wonder cash-starved states are eyeing the rollback of marijuana prohibition.

According to an article written on March 11, 2014 by Kristen Wyatt with Associated Press, Colorado made roughly $2 million in marijuana taxes in January. The tax total reported by the state Department of Revenue indicates $14.02 million worth of recreational marijuana was sold from 59 businesses. Colorado legalized marijuana in 2012, but the commercial sale of marijuana didn’t begin until January, 2014. The marijuana taxes come from 12.9% sales taxes and 15% excise taxes. Including licensing fees and taxes from Colorado’s pre-existing medical marijuana industry, the state collected about $3.5 million from the marijuana industry in January. Washington state sales will begin this summer.

“Colorado’s going to help the nation learn what works and what doesn’t,” stated Pat Oglesby, a former congressional tax staffer. The forecast by the Economic and Revenue Forecast Council showed that $51 million in revenue is expected for the 2015-2017 biennium from marijuana production and sales in the state of Washington. An additional $138.5 million is expected for the next two-year budget that ends mid-2019. A little under half of that revenue is expected from excise tax and license fees related to the marijuana market, and the rest is expected to come from retail sales tax and business taxes. If every state legalized recreational marijuana and brought in $25,000,000 per year or more, that is at least $1,250,000,000 dollars that could be used to make sure that all U.S. citizens have access to excellent healthcare, even if they earn less than the poverty level.

¹ Easley, Jonathan (March 25, 2014 12:01 AM EDT). Study: States refusing Medicaid expansion would benefit the most. The Hill. Retrieved from http://thehill.com/policy/healthcare/201527-study-states-refusing-medicaid-expansion-would#ixzz312epKVaJ

² Manes, Billy (April 9, 2014). The perils of Florida’s refusal to expand Medicaid. Orlando Weekly. Retrieved from http://orlandoweekly.com/news/the-perils-of-florida-s-refusal-to-expand-medicaid-1.1665144