For Kentucky’s sick and poor, health policy controversies are harsh realities

hep-c-imageAlthough the partisan wrangling over what’s next with American health care seems to ignore the maddening realities confronting patient-consumers,  a new look at the plight of poor Kentuckians provides a harsh look at the collision of many major health policy controversies including soaring drug prices, the Affordable Care Act, and the prescription drug abuse crisis.

Stat, the online health news site, deserves credit for the grim picture it painted of health care dysfunction in the nation’s heartland. Kentucky has been ravaged not only by opioid drug abuse, including record numbers of overdose deaths, it also is struggling with a stark, related rise in diseases.  In particular, cases of Hepatitis C have skyrocketed by 364 percent in Kentucky and surrounding states. Infections are growing most among young, rural whites, and to the growing concern of public health officials, Kentucky is recording increasing numbers of cases in which pregnant moms are infecting their babies.

Hepatitis C, a viral infection that damages the liver and is a factor in 19,000 Americans’ death annually, can lurk in the body for long periods before becoming deadly. As many as 4 million Americans may carry it and not know it until their liver damage becomes severe. The virus (depicted in the illustration above) spreads among addicts of pain-killing medications because they too often progress from prescription pill-popping to shooting up other increasingly powerful opioids like fentanyl and heroin.

New drugs attack the virus so effectively that experts say they offer a relatively fast cure with few side-effects. But the medications can cost almost $100,000 for one patient’s 12-week regimen. Drug companies have defended the giant tab for their Hep C therapies, noting they were expensive to research and develop, and they can pencil out as cheaper in the long run, since patients won’t need long, costly care for a chronic condition. Still, many states have been staggered by the cost of Hepatitis C treatment under Medicaid programs for the poor. (I’ve written, for example, how giant California was figuring how to pay a $1 billion tab for this care).

In Kentucky, the combination of the drug abuse and Hepatitis C crises has been complicated because the state’s Republican governor opposes the Affordable Care Act, aka Obamacare. Like many in his party, he wants to undo the state’s decision under Obamacare to expand Medicaid. The GOP  continues to say it will repeal and replace Obamacare, though partisans haven’t explained yet how it will be replaced. But what happens to the people harmed by these ideological policy decisions?

For poor, Hepatitis C-infected Kentuckians—who also are at high risk for HIV-AIDS infection—the future looks bleak. The Stat story describes how they, effectively, are receiving rationed care, one of the invectives opponents use against Obamacare and which say their un-provided plans would prevent. As Stat describes it, the sick poor need to get even sicker in Kentucky to get care, which costs a lot more because they are so sick.

Must the nation’s health safety net collapse and the poorest and sickest Americans suffer even more before partisans stop sloganeering or pushing fiscal sleights of hand (like the unsupported notion that allowing insurers to sell coverage across state lines magically will fix U.S. health insurance)? Yet another study has found that Americans pay some of the highest costs but see the poorest health results among western industrialized nations.  The health care system is out of whack when Americans spend $30 billion on dietary supplements that do them little good, while millions of their fellow, poor citizens struggle to pay for a tank of gas, a loaf of bread, and minimal care when they’re really sick.

The U.S. Surgeon General, rightly, has just deemed substance abuse and addiction, “not … a moral failing but … a chronic illness that must be treated with skill, urgency and compassion.” He called it a “crisis test” for the nation to provide treatment for the 1 in 7 Americans who at some point in their lives will struggle with substance abuse. Only 1 in 10 now gets such needed care.

As someone who sees in his practice the dangers of potent drugs and their abuse, I agree with the surgeon general that medical care and not stigma is key. We also need to ensure, no matter who is in political power in Washington, D.C., that this country keeps pushing to ensure we all have access to safe, affordable, and excellent health care.

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