There might not be a better lab for exploring healthcare policy and its impacts than Arizona, and in particular the effects of expanding Medicaid. It's been through that phase twice in the past few decades, and has
clearly demonstrated how the program improves health and saves lives.
In the late 1990s, a citizens initiative extended Medicaid coverage to a new population of working poor childless adults. The program was funded initially by the state's share of a legal settlement between states and the tobacco industry. The results were fast and dramatic: between 2001 and 2010 Medicaid enrollment in the state more than doubled to 1.3 million people. A study of three states—Arizona, Maine, and New York—which all expanded Medicaid pre-Obamacare showed that these states reduced mortality by 6 percent compared to neighboring states that didn't expand. But when the recession hit and tax revenues fell, that expansion ended, enrollments for childless adults frozen and many services discontinued.
Doctors and others quickly noticed changes.
At Dr. J. Manuel Arreguin's gynecology clinic on the lower-income south side of Tucson, women began delaying recommended surgery for fibroids, noncancerous growths that appear in the uterus and can cause serious bleeding.
Pima County jail officials noticed that more inmates needed extra medical attention, even kidney dialysis. Many had lost health insurance and access to medications and medical services before they were arrested.
In rural health clinics, patients started drifting away; many sought care or drugs in Mexico, said Amanda Aguirre, president of the Regional Center for Border Health.
And at Tucson Medical Center, doctors and nurses struggled to get patients to seek follow-up care.
One of the services that was cut was podiatry. The result still being felt is poor diabetics losing their legs and feet, as the disease wastes nerves and arteries in the extremities. Hospital admissions for diabetic foot ulcers rose 37 percent in that period, according to researchers, largely because primary care for diabetes—and specifically foot care—ended. The gruesome results continue below the fold.
Nearly every day, Armstrong and Dr. Joseph L. Mills, who co-direct the Southern Arizona Limb Salvage Alliance, don surgical scrubs and step into an operating room to amputate limbs or cut away diseased bones and flesh of patients with diabetes who put off seeing a doctor.
One afternoon, Armstrong's team labored to save the black, gangrenous left foot of a 30-year-old diabetic, sawing out infected bones, stitching healthy tissue and grafting skin in a bid to spare him life in a wheelchair.
"If it was just a couple of months earlier, we probably could have stopped some of these problems," Armstrong said later. "We're constantly shaking our heads."
Then the state decided to expand Medicaid again, and enrollments have surged 26 percent to more than 1.6 million. The immediate result was felt in the emergency rooms. Tucson Medical Center says that the number of people showing up in emergency with life-threatening cases has declined. The waiting list for free screenings in the hospital's breast clinic has been cut in half.
It's a clear case in favor of Medicaid expansion, showing that lives can actually be saved. But that's not enough for Arizona Republicans, not by a long shot. A group of GOP lawmakers is suing to have the Medicaid expansion in their state repealed, and the incoming Republican governor, Doug Ducey, hasn't said whether he'll continue the expansion. So the life-and-death Medicaid experiment in Arizona could continue.