Want to improve health care in Kansas and make it cost less? Easy: Expand Medicaid | Opinion

More than 10 years ago, I was asked by the executive director of the Kansas Health Insurance Association for advice as to how to deal with the costs of caring for the persons with diabetes who were in the Kansas high-risk pool insurance program. At the time, the costs of care for these Kansas residents were so high as to make the high-risk insurance program unsustainable.

Why am I concerned? I am a physician and a clinical endocrinologist who specializes in diabetes and has provided health care for many patients from Kansas and Missouri. My team and I had published data showing how our practice had reduced death rates and kidney failure rates in those patients with diabetes. Also, I was involved nationally in multiple efforts to improve diabetes care for all patients with diabetes, and today, I continue to advise national organizations regarding optimal diabetes care. For more than 25 years, I have had the privilege of providing advice to both Republican and Democratic administrations in Washington, D.C., as well as to many national groups involved in these worthwhile endeavors.

The advice I gave was simple. Improve early access to quality diabetes care. Diabetes is a serious disease that costs the nation more than $400 billion annually, and it is most expensive when care is delayed. In my more than 50 years as a specialist in diabetes care, it has almost always been the case that if people do not have access to affordable care, and have limited means — particularly if they are uninsured — they will choose to feed their family and keep a roof overhead first, and neglect their health care, with devastating consequences to themselves.

One of the reasons why the pooled risk insurance program was not going to survive was that it was providing too little too late. Waiting for people to get sick enough that they are uninsurable by private insurance makes no fiscal sense. From a medical perspective, this is exactly the wrong way to get a good outcome. Good care for a person with diabetes is early care, which in most cases can prevent the complications that create a downhill spiral that too often leads to suffering, disability and premature death, as well as high costs.

Today, Kansas is involved in a debate on the expansion of Medicaid. If the opposition to expansion is a fear that it will cost the state more, that fear is misguided. Diabetes care is far less expensive if care is given early. Medicaid expansion would increase the likelihood that care will be available earlier in many other chronic diseases, and just as with diabetes care, many disorders — including both cancer and cardiovascular disease — are disorders where prevention, early diagnoses and early treatment save not only lives and health, but reduce costs.

One of the many areas where our health care system fails our citizens is in the health of our mothers and unborn children. Our nation has among the very highest infant and maternal mortality rates in the world. One of the key reasons is lack of health care access beginning before women become pregnant, as well as early in pregnancy — particularly among those with chronic conditions such as diabetes. Again, the remedy is early access to quality care. The benefit is impossible to overstate. Early care can reduce birth defects in an unborn child with a diabetic mother by up to 80%, and reduce the risk of having a stillborn baby by up to 90%.

If preserving life, particularly of the unborn, is as important to you as it is to me, the easier the access to health care — and the broader it is — the more likely it is to be timely and successful. The lack of Medicaid expansion in Kansas is devastating to women, and to all those with chronic illnesses, and expanding Medicaid would help keep our rural communities intact. Hospitals outside larger cities need the funds that would accrue from Medicaid expansion, which in many situations are closer to the real costs of care than private insurance pays. Medicaid expansion in Kansas would provide this, and reduce the costs of care as well.

Medicaid expansion in Kansas is one of those instances where doing what is right from a moral point of view is both scientifically sound and saves money. I hope we can get Medicaid expansion passed during this session of the Legislature.

Richard Hellman is a retired clinical professor of medicine at the University of Missouri-Kansas City School of Medicine and past president of the American Association of Clinical Endocrinology.