Story written by Edward, a retired Emergency Room nurse in Kansas City:
People came to the emergency room in crisis because they couldn’t receive primary care they needed. More so, they haven’t been able to procure the medications they need for ongoing chronic conditions. So you take two conditions, like diabetes and cardiovascular disease (arrhythmia, congestive heart failure, etc.). These can easily be controlled if you are taking medications on a regular basis. When people do not have money and do not have insurance, they tend to not buy their medications or they buy them in inadequate quantities as well as engaging in trade-offs between other living expenses and in the meantime their conditions worsen exponentially.
This presents a constant conundrum for folks that live on the margins. When they show up in the ER, it costs the state or the county. I worked in a teaching county-supported non-profit hospital, and their clientele was very reflective of the population. Accessing care that costs a few thousand dollars to be seen and stabilized in our facility whereas preventative care could have kept them even keel for a fraction of the cost. As their health worsens they need to be admitted to hospital for multiple days of acute care, then discharged when they return to a baseline, return to community (and [the hospital] might provide with medication for short period of time on discharge), then they run out of that refill and the cycle continues. It costs the people much more money than we are going to spend to expand Medicaid especially since we already paying 90%.