10 Dumb things about Medicaid

I read many rants on Medicare (and write some myself), but what about Medicaid?  To those who don\’t know, Medicaid is a health insurance plan funded by the federal government, administered by the individual states, aimed at people who are living in poverty.

We accept Medicaid mainly for the kids.  A significant proportion of Children are on Medicaid or other related plans, and so most pediatricians accept it.  A lower percent of family and internal medicine practices accept it (see below).

In general, our practice tries hard not to disrespect our Medicaid patients (as other practices are known to do), treating them the same as our \”paying\” patients.  Still, while many of the stereotypes about these patients do not apply to every patient, these stereotypes came to be for a reason.  Perhaps it is a minority of the Medicaid population, but it is a substantial minority.

So here is the stupid things about Medicaid.

  1. Reimbursement – I sound like a broken record, but the reimbursement for medicaid is very bad – especially for adults.  With the complexity (both medically and socially) of the adult Medicaid population, it is extremely hard to make ends meet on what they pay.
  2. Different Medicaid for different states – This is bad if, like us, you live on a state line.  You need to deal with totally different plans with their own idiosyncratic rules.  At least with Medicare you need to learn one set of hoops to jump through.
  3. No humans – If you have problems with the way Medicaid does things, you rarely can get a person on the phone.  There are no medical directors to appeal to.  In general, if you have a problem with their decision, you have to live with it.  This is not true with the Medicaid managed care products.
  4. Medicaid Managed Care – Yes, you can get a human, but generally someone who knows only what is in front of them on the computer screen and yet has power to say you are wrong.  They have totally different rules, different formularies, more arduous authorization processes with each of these plans.  We have two of them in our state and it is like having to choose between hanging or being shot.
  5. Drug Seekers – No, not all Medicaid patients are drug seekers, but a disproportionate number of them are.  These people are constantly finding ways to get you to write a controlled drug, often going to other providers when you won\’t comply.  Drug seekers hurt all Medicaid patients in that they put a cloud of suspicion over any Medicaid patient that seems to be in pain.
  6. ER overuse – The cost to Medicaid patients of going to the ER is the same as it is to go to see you.  Nothing.  This means that far more of them will be willing to take their kid to the ER for an ear infection, even when you have a walk-in clinic they can go to.  This means that you don\’t know really what medications many of them have gotten, since their care is so fragmented.
  7. Entitlement – The entitlement mentality is one in which the person does not think they should be expected to pay for things.  They are so used to getting a free-ride that they recoil at the idea of paying for things.  I get many requests for prescriptions of OTC medications or cough/cold equivalents that are prescription.  I have to pay for them, why shouldn\’t they?
  8. Cancellation – Patients can mysteriously be canceled for Medicaid, and have no recourse but to wait until the next month to be reinstated.  This means that we are caught having to decide if we are going to charge normal amounts for these folks with no insurance, hoping when it is reinstated they will pay retroactively; or we try and drag our feet until it is reinstated.  If we do the former, we are stuck with a bill to a person who cannot pay.  If we do the latter, we may harm people.
  9. Formularies – These have gotten out of hand lately.  It used to be that we could write generics and they would all be accepted.  Any of the cheap cough/cold medications would also be paid for without having to hoop jump.  Now they only accept certain generics and pay for certain cold medications.  Often the pharmacist has no list as to what is accepted, and so they have to run one drug through at a time.  It is costing us dollars to save them pennies.
  10. Fear of Audit – Like Medicare, it is a criminal offense to bill incorrectly to Medicaid.  This means that if you don\’t document exactly to the letter of the law (see Happy for more details on that one), you could be brought up for defrauding the government.  With how little you get paid, it is sometimes not worth the trouble and you just end up down-coding the visit to play it safe.

There are some things I do like about Medicaid.  The drug coverage is much better than Medicare, and they do pay for well care (and at a good rate for children).  But the pains of dealing with it have many providers saying \”No\” to Medicaid, which is a shame because serving the poor should be the rule for physicians, not the exception.

16 thoughts on “10 Dumb things about Medicaid”

  1. Brilliant!!!!!! Love this, was reading your other blogs, and you are a very amusing physician! Critical Care RN in St. Louis. Do one on Medicare, and the frivoulous wasting of hundreds of thousands of dollars on patients that will NEVER get better. Terminal/Futile care with the patient dying regardless of intervention. Then the hospital only gets 30% or so of the reimbursement and eats the rest. This will eventually trickle down to affect us all, in rising healthcare costs for persons with private insurance, and less staffing ratios to decrease hospital costs. (currently our facility is downsizing and hours are scarse) It chaps my ass. (sorry to curse, but I am so damn mad right now)

  2. Brilliant!!!!!! Love this, was reading your other blogs, and you are a very amusing physician! Critical Care RN in St. Louis. Do one on Medicare, and the frivoulous wasting of hundreds of thousands of dollars on patients that will NEVER get better. Terminal/Futile care with the patient dying regardless of intervention. Then the hospital only gets 30% or so of the reimbursement and eats the rest. This will eventually trickle down to affect us all, in rising healthcare costs for persons with private insurance, and less staffing ratios to decrease hospital costs. (currently our facility is downsizing and hours are scarse) It chaps my ass. (sorry to curse, but I am so damn mad right now)

  3. mottsapplesauce

    Loved this Dr. Rob– I know this subject all too well. I deal mainly with children withcongenital defects & what I hate most about the Medicaid system is that no one is accountable for their errors, or if their work is back logged. And you’re absolutely right about the managed care programs. Their processing systems may be more arduous but are also more up to date compared to the states’ systems. Right now, Ohio alone has over 20,000 outstanding authorizations. I work in the DME industry, but I don’t know if this accounts just for this particular healthcare field or all of them. Some of our competitors have had patients expire while waiting for their equipment. Very sad & frustrating.

  4. mottsapplesauce

    Loved this Dr. Rob– I know this subject all too well. I deal mainly with children withcongenital defects & what I hate most about the Medicaid system is that no one is accountable for their errors, or if their work is back logged. And you’re absolutely right about the managed care programs. Their processing systems may be more arduous but are also more up to date compared to the states’ systems. Right now, Ohio alone has over 20,000 outstanding authorizations. I work in the DME industry, but I don’t know if this accounts just for this particular healthcare field or all of them. Some of our competitors have had patients expire while waiting for their equipment. Very sad & frustrating.

  5. My daughter is on Medicaid due to our low income, but I actually have to pay for it just like regular old insurance (to add her to my insurance would cost an extra $475/month which is money that I could not come up with unless I found a second job).
    It’s funny that one or two of the things you mentioned (like getting ahold of a real person who can actually think) bother me as well. I know I thank you and all other pediatricians who accept this type of insurance from the very bottom of my heart. I know from reading blogs would difficult this type of insurance can be, and I do want you to know that I as a parent appreciate it.

  6. My daughter is on Medicaid due to our low income, but I actually have to pay for it just like regular old insurance (to add her to my insurance would cost an extra $475/month which is money that I could not come up with unless I found a second job).
    It’s funny that one or two of the things you mentioned (like getting ahold of a real person who can actually think) bother me as well. I know I thank you and all other pediatricians who accept this type of insurance from the very bottom of my heart. I know from reading blogs would difficult this type of insurance can be, and I do want you to know that I as a parent appreciate it.

  7. Medicaid writes it’s own rules, much of it dependent on federal funding. It is a hodgeppodge of state programs, disconnected from each other, each one running on it’s own track. The share of cost issues defy analytic thought. The numbers given for level of poverty are very unrealistic and worse than that wrong. The computation of disposable income, ie non exempt income, and exempt income is byzantine. The family’s total income is counted but proportioned differently to different members of the family (children) without income. The rules change when a child reaches the age of 18, although they are still eligible until age 20. The eligibility workers are unable to explain the rules logically…they put numbers into a computer program and it spits out what the state’s budget allows. Rules change. No one answers the telephones, and rarely return messages. There are many people (adults) who are disabled, unable to work, and some who can no longer obtain insurance since they are too young for medicare.From a patient’s perspective it is a worse nightmare than it is for physicians.
    Our nation has become a third world undeveloped country when it comes to the uninsured. It’s a bit like the hit movie “Independence Day” when the alien is asked what do you want us to do?? THE ANSWER IS DIE!

  8. Medicaid writes it’s own rules, much of it dependent on federal funding. It is a hodgeppodge of state programs, disconnected from each other, each one running on it’s own track. The share of cost issues defy analytic thought. The numbers given for level of poverty are very unrealistic and worse than that wrong. The computation of disposable income, ie non exempt income, and exempt income is byzantine. The family’s total income is counted but proportioned differently to different members of the family (children) without income. The rules change when a child reaches the age of 18, although they are still eligible until age 20. The eligibility workers are unable to explain the rules logically…they put numbers into a computer program and it spits out what the state’s budget allows. Rules change. No one answers the telephones, and rarely return messages. There are many people (adults) who are disabled, unable to work, and some who can no longer obtain insurance since they are too young for medicare.From a patient’s perspective it is a worse nightmare than it is for physicians.
    Our nation has become a third world undeveloped country when it comes to the uninsured. It’s a bit like the hit movie “Independence Day” when the alien is asked what do you want us to do?? THE ANSWER IS DIE!

  9. The Largest Cuts in The History Of Medicaid That Has Never Recovered
    In 2005, Missouri experienced the most severe Medicaid cuts since the program began 30 years from then. Already, near 1 million Missourians are uninsured. So Blount chops 100,000 from Medicaid, who needed the resources the most. In addition, Blount had another 300,000 Medicaid patients have their medical benefits greatly reduced.
    Limited income parents suffered the most, as more than 50,000 of them lost medical coverage for their families. And after Blount stated in 2007 that Missouri is now strong, prosperous, and vibrant, he never repaired at all the damage he did to those suffering Missourians in 2005. Remember that most on Medicaid in Missouri are children. In the U.S., the total cost of Medicaid is around 300 billion dollars a year.
    The joy he must experience in seeing or knowing of the suffering of others must continue still, as the Missouri House of Representatives rejected a bill to expand Medicaid coverage greatly needed due to the actions of the governor.
    Medicaid is also a necessity for the over 500 nursing homes in Missouri. The Nursing Home Inspectors already are accused of ignoring deficiencies in these nursing homes, which may include malnutrition and bed sores of the residents, and their inappropriate use of pharmaceuticals as well. In addition, in Missouri, Nursing homes are inspected only once a year. The inspectors should be more monitored by the GAO because of safety issues in nursing homes. For example, around 25 percent of Missouri nursing homes were found to have deficiencies. The rest of the nation only has a rate of 15 percent. Also, the homes are only covered by Medicaid. Typically, Nursing Homes cost each patient there over 5000 dollars a month. Yet patients tend to experience loneliness and displacement due to staying at such facilities. Dementia is a common disease as we get older and is seen in Nursing homes. Basically, it is a disease of cognitive and brain dysfunction that usually is not reversible. If it’s the cortical kind, it is combined with Alzheimer’s disease. If it is the subcortical kind, look for Parkinson’s disease to be experienced for these patients.
    To complicate our state health care situation further, because close to 90 percent of Missouri counties are rural, with most lacking hospitals, there is only one doctor for every 3500 or so residents. There is something to help called a Certificate of Need, or CON. Issued by regulatory agencies, they authorize healthcare facility creation and expansion as determined by the perceived needs of any community.
    5 million people in Missouri are and have Medicaid. Missouri pays 20 percent of that bill, with the government paying the rest. While the states manage Medicaid for their state, CMS monitors and regulates the states. In 1990 Medicaid came out with the drug rebate program, which helped many. The Missouri Healthnet Division is responsible for making the best of the MO Medicaid funds.
    With Medicaid, over 6 million people in the U.S. also have Medicare, and they are known as ‘dual eligible’s’. In the U.S., over 40 million people have Medicare. This costs 300 billion per year as well.
    With seniors, government health care programs pay for quite a bit. Long term care costs Missouri about 2 million dollars a year. About 10 million elderly U.S. residents are in LTC. Only Medicaid pays for this as well. Homecare is one form of LTC, and preferable to many.
    The Medicaid for children is called SCHIP, and was created over 10 years ago. This program is facing funding shortfalls in many states. Of course, Bush vetoed a bill for SCHIP expansion and reauthorization recently, and the House was unable to over-ride this veto and some others he has implemented for the benefit of the U.S. citizens. The cost for this program for children is around 4 billion dollars a year.

    MO Health Dept. Head: Jane Drummond
    MO Medicaid Director: Steven Renne

    Dan Abshear

  10. The Largest Cuts in The History Of Medicaid That Has Never Recovered
    In 2005, Missouri experienced the most severe Medicaid cuts since the program began 30 years from then. Already, near 1 million Missourians are uninsured. So Blount chops 100,000 from Medicaid, who needed the resources the most. In addition, Blount had another 300,000 Medicaid patients have their medical benefits greatly reduced.
    Limited income parents suffered the most, as more than 50,000 of them lost medical coverage for their families. And after Blount stated in 2007 that Missouri is now strong, prosperous, and vibrant, he never repaired at all the damage he did to those suffering Missourians in 2005. Remember that most on Medicaid in Missouri are children. In the U.S., the total cost of Medicaid is around 300 billion dollars a year.
    The joy he must experience in seeing or knowing of the suffering of others must continue still, as the Missouri House of Representatives rejected a bill to expand Medicaid coverage greatly needed due to the actions of the governor.
    Medicaid is also a necessity for the over 500 nursing homes in Missouri. The Nursing Home Inspectors already are accused of ignoring deficiencies in these nursing homes, which may include malnutrition and bed sores of the residents, and their inappropriate use of pharmaceuticals as well. In addition, in Missouri, Nursing homes are inspected only once a year. The inspectors should be more monitored by the GAO because of safety issues in nursing homes. For example, around 25 percent of Missouri nursing homes were found to have deficiencies. The rest of the nation only has a rate of 15 percent. Also, the homes are only covered by Medicaid. Typically, Nursing Homes cost each patient there over 5000 dollars a month. Yet patients tend to experience loneliness and displacement due to staying at such facilities. Dementia is a common disease as we get older and is seen in Nursing homes. Basically, it is a disease of cognitive and brain dysfunction that usually is not reversible. If it’s the cortical kind, it is combined with Alzheimer’s disease. If it is the subcortical kind, look for Parkinson’s disease to be experienced for these patients.
    To complicate our state health care situation further, because close to 90 percent of Missouri counties are rural, with most lacking hospitals, there is only one doctor for every 3500 or so residents. There is something to help called a Certificate of Need, or CON. Issued by regulatory agencies, they authorize healthcare facility creation and expansion as determined by the perceived needs of any community.
    5 million people in Missouri are and have Medicaid. Missouri pays 20 percent of that bill, with the government paying the rest. While the states manage Medicaid for their state, CMS monitors and regulates the states. In 1990 Medicaid came out with the drug rebate program, which helped many. The Missouri Healthnet Division is responsible for making the best of the MO Medicaid funds.
    With Medicaid, over 6 million people in the U.S. also have Medicare, and they are known as ‘dual eligible’s’. In the U.S., over 40 million people have Medicare. This costs 300 billion per year as well.
    With seniors, government health care programs pay for quite a bit. Long term care costs Missouri about 2 million dollars a year. About 10 million elderly U.S. residents are in LTC. Only Medicaid pays for this as well. Homecare is one form of LTC, and preferable to many.
    The Medicaid for children is called SCHIP, and was created over 10 years ago. This program is facing funding shortfalls in many states. Of course, Bush vetoed a bill for SCHIP expansion and reauthorization recently, and the House was unable to over-ride this veto and some others he has implemented for the benefit of the U.S. citizens. The cost for this program for children is around 4 billion dollars a year.

    MO Health Dept. Head: Jane Drummond
    MO Medicaid Director: Steven Renne

    Dan Abshear

  11. chris and vic

    Rob, yes, yes and yes. But our whole culture has a sense of entitlement, I feel. You can feel entitled to healthcare if you are on Medicare/Medicaid. You can feel entitled to gov’t supports if you are in certain industries.
    I try to think of the big picture: What do we want to provide for all members of our society? Do we want everyone to be able to access healthcare, same as we want everyone to be able to access a free and appropriate public education? Do we want every community to enjoy good roads and road maintenance (snow plowing in my area)? What do we want our taxes to pay for? War? Space exploration? National parks? Do we want to sponsor law enforcement? Public defenders? State universities?

    I, for one, want everyone to have a free public education through high school graduation. I also want healthcare for all. I think that a society at our stage of development/sophistication should provide for these. Roads? I think there is a question about how wonderful/extensive the highway system should be? I would forego some space exploration. I would forego all wars.

    The healthcare system we have now is inadequate in many ways. Medicaid is one of the ways. I happen to live in a state where Medicaid reimbursement is in the lowest 10% of all states, paying $0.13-$0.14 cents on the dollar. My son, Vic, has Medicaid coverage, and my mother, since we have used up her estate to private-pay for her nursing home, is now dual-eligible.

    I, too, am eternally grateful for the docs who are willing to see my son, with his complex needs, given his Title XIX/Medicaid coverage. He would be dead many times over if the docs wouldn’t have taken him on at much reduced reimbursement rates. (Dentists are another story in my area–most will NOT take Medicaid patients.) Docs solve this problem in my area by only allowing a certain percentage of their practice to be Medicaid/Medicare. I assume that writing-off these unreimbursed expenses also helps solve the problem.

    I think that those patients who manipulate the system to their advantage are no better and no worse than wealthy people/businesses that manipulate the tax laws to their advantage. Desperate people may do desperate things–they are in survival mode. They become opportunists by necessity. I serve this population, almost exclusively. And I like them–genuinely. They are like children–powerless, except for what they can beg or manipulate. Society bears a great deal of responsbility for turning them into beggars. I have a much bigger problem with wealthy people/businesses which slip through the tax loopholes they have sought.
    C & V

  12. chris and vic

    Rob, yes, yes and yes. But our whole culture has a sense of entitlement, I feel. You can feel entitled to healthcare if you are on Medicare/Medicaid. You can feel entitled to gov’t supports if you are in certain industries.
    I try to think of the big picture: What do we want to provide for all members of our society? Do we want everyone to be able to access healthcare, same as we want everyone to be able to access a free and appropriate public education? Do we want every community to enjoy good roads and road maintenance (snow plowing in my area)? What do we want our taxes to pay for? War? Space exploration? National parks? Do we want to sponsor law enforcement? Public defenders? State universities?

    I, for one, want everyone to have a free public education through high school graduation. I also want healthcare for all. I think that a society at our stage of development/sophistication should provide for these. Roads? I think there is a question about how wonderful/extensive the highway system should be? I would forego some space exploration. I would forego all wars.

    The healthcare system we have now is inadequate in many ways. Medicaid is one of the ways. I happen to live in a state where Medicaid reimbursement is in the lowest 10% of all states, paying $0.13-$0.14 cents on the dollar. My son, Vic, has Medicaid coverage, and my mother, since we have used up her estate to private-pay for her nursing home, is now dual-eligible.

    I, too, am eternally grateful for the docs who are willing to see my son, with his complex needs, given his Title XIX/Medicaid coverage. He would be dead many times over if the docs wouldn’t have taken him on at much reduced reimbursement rates. (Dentists are another story in my area–most will NOT take Medicaid patients.) Docs solve this problem in my area by only allowing a certain percentage of their practice to be Medicaid/Medicare. I assume that writing-off these unreimbursed expenses also helps solve the problem.

    I think that those patients who manipulate the system to their advantage are no better and no worse than wealthy people/businesses that manipulate the tax laws to their advantage. Desperate people may do desperate things–they are in survival mode. They become opportunists by necessity. I serve this population, almost exclusively. And I like them–genuinely. They are like children–powerless, except for what they can beg or manipulate. Society bears a great deal of responsbility for turning them into beggars. I have a much bigger problem with wealthy people/businesses which slip through the tax loopholes they have sought.
    C & V

  13. I share your angst, on both sides of the equation…as a disabled MD and as a parent with two disabled dependents, one a child with cystic fibrosis and a spouse witha disabling neurologic condition.The medicaid system is administered by the state and/or county and largely funded by the federal government…Many duplicated steps which probably increase the costs of administration. Many physicians would accept medi-cal even with the low reimbursement rates, however the bureaucracy of billing for medicaid is terrible. There is no way to check on claims for medi-cal. For the patient’s sake the charges need to be in the system for t hose with share of cost the charges need to be in the system.
    Billing medicaid is fraught with charges of fraud for innocent errors in coding and billing.
    Increasing a medicaid load displaces a paying patient. This sounds harsh and crude, but it is now a more than realistic concern since payors, HMOSs, medicare, etc have cut reimbursements not only the fat, but muscle and bones. Most practices hover barely abel to cover payroll, premiums,witholding taxes. A lot of MDs would and do seen medicaid patients, not bill and either markedly adjust the fee, or ‘write it off”.
    As many patients mistakenlly believe the term “write off” for a doctor’s office is not the same as business corporations that use a different accounting system. Unlike these companies thave losses or ‘write downs’ physicians are not allowed to get credits or show these non payments as a loss. Physicians can not use the accrual method of accounting.
    If our government had any sense (which we know it does not), it would give physicians either a large deduction or a tax credit for these write offs as a percentage of the business;s total income.
    If that were to take place, and the hospitalls (that are for profit) were given this option……you would see almost immediately care for the uninsured, or impoverished. Our system punishes MDs for caring for medicaid and the uninsured. I am certain Dr Rob would agree with me, How about it Rob, what’s your take?
    In my case my son is uninsurable because of his high risk. Fortunately (relatively speaking) he is covered by a special program in California called CCS, unrelated to medi-caid….At one tme when he was covered by my own group coverage, his medications wouldl run about 5000/month, even when he was well.

  14. I share your angst, on both sides of the equation…as a disabled MD and as a parent with two disabled dependents, one a child with cystic fibrosis and a spouse witha disabling neurologic condition.The medicaid system is administered by the state and/or county and largely funded by the federal government…Many duplicated steps which probably increase the costs of administration. Many physicians would accept medi-cal even with the low reimbursement rates, however the bureaucracy of billing for medicaid is terrible. There is no way to check on claims for medi-cal. For the patient’s sake the charges need to be in the system for t hose with share of cost the charges need to be in the system.
    Billing medicaid is fraught with charges of fraud for innocent errors in coding and billing.
    Increasing a medicaid load displaces a paying patient. This sounds harsh and crude, but it is now a more than realistic concern since payors, HMOSs, medicare, etc have cut reimbursements not only the fat, but muscle and bones. Most practices hover barely abel to cover payroll, premiums,witholding taxes. A lot of MDs would and do seen medicaid patients, not bill and either markedly adjust the fee, or ‘write it off”.
    As many patients mistakenlly believe the term “write off” for a doctor’s office is not the same as business corporations that use a different accounting system. Unlike these companies thave losses or ‘write downs’ physicians are not allowed to get credits or show these non payments as a loss. Physicians can not use the accrual method of accounting.
    If our government had any sense (which we know it does not), it would give physicians either a large deduction or a tax credit for these write offs as a percentage of the business;s total income.
    If that were to take place, and the hospitalls (that are for profit) were given this option……you would see almost immediately care for the uninsured, or impoverished. Our system punishes MDs for caring for medicaid and the uninsured. I am certain Dr Rob would agree with me, How about it Rob, what’s your take?
    In my case my son is uninsurable because of his high risk. Fortunately (relatively speaking) he is covered by a special program in California called CCS, unrelated to medi-caid….At one tme when he was covered by my own group coverage, his medications wouldl run about 5000/month, even when he was well.

  15. Entitlement – The entitlement mentality is one in which the person does not think they should be expected to pay for things. They are so used to getting a free-ride that they recoil at the idea of paying for things. I get many requests for prescriptions of OTC medications or cough/cold equivalents that are prescription. I have to pay for them, why shouldn’t they? >>>
    It’s called poverty, Doc., … I have Muscular Dystrophy and am on SSI ..I cannot afford rent, electricity, gas, food, disability related expenses etc on what I get each month. I probably could not afford the syrup, I’d have to wait for the mucous to build up in my lungs, get pneumonia and hit you up for an exray, antibiotics. Costing the taxpayers a few hunderd extra dollars for a second appointment and the cost of the antibiotics, perhaps even a hospital stay… People make choices between medicine and food all the time, people in poverty tend to choose food.. I suffer from wasting/anorexia (6’1 and been down as low as 75 lbs) and struggle each month to find resources for food.

  16. Entitlement – The entitlement mentality is one in which the person does not think they should be expected to pay for things. They are so used to getting a free-ride that they recoil at the idea of paying for things. I get many requests for prescriptions of OTC medications or cough/cold equivalents that are prescription. I have to pay for them, why shouldn’t they? >>>
    It’s called poverty, Doc., … I have Muscular Dystrophy and am on SSI ..I cannot afford rent, electricity, gas, food, disability related expenses etc on what I get each month. I probably could not afford the syrup, I’d have to wait for the mucous to build up in my lungs, get pneumonia and hit you up for an exray, antibiotics. Costing the taxpayers a few hunderd extra dollars for a second appointment and the cost of the antibiotics, perhaps even a hospital stay… People make choices between medicine and food all the time, people in poverty tend to choose food.. I suffer from wasting/anorexia (6’1 and been down as low as 75 lbs) and struggle each month to find resources for food.

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