Writings and observations

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The story of how and why Jenny Steinke died last summer might be the kind of story that would goad a legislature into action. That’s because, had the legislature voted differently at any point over the last few sessions, she might be alive today.

Jenny Steinke, 36, of Idaho Falls, had for some years endured asthma, but generally managed it with the use of inhalers. In late August, her condition got worse, but she and her husband Jason put off medical treatment until insurance at Jason’s new job started on September 1. For a long time up to then they had been uninsured, since their employers hadn’t provided health insurance as part of the employment package. A serious brush with the medical profession, not to mention an actual useful health insurance policy, was financially either out of reach or a disastrous proposition.

The Steinkes were not a rare fluke case in their lack of health insurance. State officials have estimated 78,000 Idahoans are similarly caught in a gap, outside the provisions for a state health insurance exchange policy, or for Medicaid coverage. In many other states, as part of the Obamacare effort, Medicaid was extended to cover people like the Steinkes. Idaho is one of the states where it hasn’t been; while several task forces have recommended the expansion, the legislature has been resistant.

With medical assistance, asthma usually isn’t life-threatening. But Jenny Steinke’s case got worse quickly, unexpectedly fast, and hit a crisis. By the time she got to an emergency room, she was in a desperate condition. About three days later, she died.

On Tuesday Jenny Steinke’s physician, Kenneth Krell, the critical care director at Eastern Idaho Regional Medical Center, reflected on her case as he spoke to the Senate Health and Welfare Committee about the possibility of Medicaid expansion.

Krell told how the Steinke case, and others not so different, and their implications haunted him: “I kept asking myself, how could this be? How could, in a state like Idaho where we care about each other, could I be seeing deaths and really damaging illness on a nearly daily basis as a result of failure to expand Medicaid that cost tangible lives? It’s difficult to understand.”

He added, “Nearly one patient per day dies in this state as a result of not having Medicaid expansion. And that’s a direct result of that failure to obtain care at a stage when the disease process could be treated effectively and not only death, but hospitalization and illness prevented.”

That adds up, as the headlines around the state noted, to around 1,000 Idahoans who have died over the last three years because the legislature chose not to expand the reach of Medicaid.

After the hearing, no vote on Medicaid expansion was taken by the committee. The chairman did not, however, rule out a vote at some later time.

If Jenny Steinke were the only person who died because of that decision, the moral case involved here would be clear enough. But hundreds of Idahoans dying every year?

All legislative decisions involve weighing the good and the bad, and sometimes those decisions are close and difficult. (This is not, I should note, a case of inadequate resources; the state would actually save money with Medicaid expansion.)

Here, you have a lot of lives on one side of the equation, and on the other side – well, what, exactly, is it in this decision that is worth more than saving a life every day?

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