RATES & RATINGS from the doctor’s corner

The following op-ed was published by the Naples Daily News on Sunday, October 21, 2018.

Allen Weiss MD, MBA, FACP, FACR President CEO, NCH Healthcare System

Astoundingly, Florida has the fourth-from-the-bottom worst medical care in America according to the Commonwealth Fund’s 2018 metrics. Further, Florida has dropped four places this past year based on five criteria: access/affordability, prevention/treatment, avoidable hospital use/cost, healthy lives, and disparity. Only Louisiana, Oklahoma, and Mississippi rate lower than Florida. Hawaii, a Blue Zones state that has embraced Medicaid expansion, is ranked first in the nation.

Specific Florida rankings include: “adult rich/poor insurance access disparity” 43rd; “disparity in rich/poor adults who report poor health” 44th; “adults without a usual source of care” 45th; “adults who went without care because of cost” 47th; “adult without all age-appropriate vaccines” 49th; and “hospital readmissions and Medicaid reimbursement per person” 50th. • https://interactives.commonwealthfund.org/2018/statescorecard/state/florida/

Florida also remains one of eighteen states rejecting funding to expand Medicaid coverage to people in households with income at or below 138% of the federal poverty level. Florida’s current uninsured rate is 13.3%, exceeding the national average of 9.4%. These facts, according to the U.S. Census Bureau’s most recent estimates, show 2.6 million Floridians do not have health insurance coverage.

Only four states have higher percentages of uninsured: Texas 17.1%, Georgia and Oklahoma 13.9%, and Alaska 14.9%. • https://www.fpi.institute/uninsuredratedeclines/.  A New England Journal of Medicine Special Article, entitled “Mortality  and Access to Care among Adults after State Medicaid Expansions,” validated that mortality reductions are greatest among
older adults, nonwhites, and residents of poorer counties with Medicaid expansion. In expansion states four measures improved:
(1) Medicaid coverage increased by 2.2%; (2) self-reported health status of “excellent” or “very good” went up 2.2%; (3) medically insured grew by 3.2%; and (4) delayed care dropped by 2.9%. • https://www.nejm.org/doi/full/10.1056/NEJMsa1202099 “Meaningful healthcare coverage is critical to living a productive,
secure, and healthy life,” is a wise quote from the American Hospital Association (AHA). As a healthcare professional and an
AHA Board member, I fully support this position. “The number of people with health insurance has increased significantly over the past five years, with more than 20 million individuals newly insured [nationally]. Most of these individuals were able to enroll in coverage offered through the Medicaid program, their employer, or the individual market as a result of coverage programs and insurance market reforms authorized by the Affordable Care Act (ACA).” • https://www.aha.org/system/files/2018-04/report-coverage-overview-2018_0.pdf

How does Collier County’s health relate? While Hawaii ranks first of 50 states and the District of Columbia in overall health status according to the Commonwealth Fund, Southwest Florida (a Blue Zones region like Hawaii) ranks first in the nation for longest life expectancy—one that is also lengthening. Moreover, Hawaii has improved this past year in access/affordability and prevention/treatment.

Locally, Southwest Florida also enjoys improvement as the healthiest and happiest region three consecutive years according to the Gallup- Sharecare poll. Had Florida accepted Medicaid expansion, Collier County’s 17% of the 358,000 population who are uninsured (according to the Collier County Public Health Department) would have benefited, not only bringing equity locally but also matching residents’ wellness in the 32 expansion states and the District of Columbia.

Florida’s fear of increased cost by embracing expansion has proven unfounded. Florida should emulate the success of Hawaii
and Collier to decrease cost and improve health. • https://www.nejm.org/doi/pdf/10.1056/NEJMp1613981 • https://www.kff.org/medicaid/issue-brief/the-effects-ofmedicaid-expansion-under-the-aca-updated-findings-from-aliterature-review-march-2018/

Helping everyone across Florida and our nation live longer, happier, and healthier lives is the right thing to do and should be
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