I have lived and worked in rural Alabama as a pediatrician since 1980. I have participated in the expansion of Medicaid for children up to age 19. I am very proud to say that because of Medicaid and the Children’s Health Insurance Program (CHIP), now only 2 percent of Alabama’s children are uninsured. Preventive care has increased with excellent immunization rates, access to dental care and a substantial drop in teen pregnancies, as well as many other healthy changes for our children. I have witnessed the vast improvements in the care of maternity patients.

Unfortunately, adults 19 and older who are too old for Medicaid and too young for Medicare have a difficult time acquiring and keeping insurance in Alabama.

Who suffers?

(1.) Women in childbearing years who have chronic illnesses and no care until they are several weeks pregnant; (2.) rural hospitals providing uncompensated care for an ageing and less-healthy population; (3.) our entire mental-health system plagued with high turnover rates and limited staff due to inadequate funding; (4.) our entire population in rural areas, and (5.) ultimately all of Alabama.

I have worked in the same community my whole career and have watched my patients turn 19 and struggle to afford health care -- especially medications. In fact, the largest number of uninsured are young adults, including women during the childbearing years. There are several consequences of these patients losing Medicaid.

Those with chronic illnesses try hard to be classified as disabled, primarily so they can still qualify for health insurance. Patients with sickle cell disease, asthma, congenital heart disease, chronic depression or anxiety disorders, hypertension, epilepsy or diabetes often lose their desire to become productive adults once they are classified as “disabled.”

Women who have no health insurance go untreated for these chronic diseases until they are pregnant. Their pregnancy starts as high risk. Usually it’s the second trimester of pregnancy when 50 percent of women once again qualify for Medicaid. Six weeks after the delivery of their child, they are again without care. We now have the highest infant mortality in the nation -- probably because we do not care for our young women appropriately.

Rural hospitals have been especially hard hit. They are trying to care both for patients without insurance and a prematurely aging population. My own local hospital is now operating in the red, like so many other rural hospitals. We have a very busy emergency room and are on the front line for stabilizing extremely sick patients and accident victims. We also have an ongoing increase of mentally ill patients with nowhere to send them quickly other than the local jail.

Mental health services are sorely limited in Alabama. Most mentally ill patients are too old for Medicaid and too young for Medicare. Medicaid expansion to adults under 138 percent of the poverty level may well be the shot-in-the arm to save our mental-health programs and rural hospitals.

When I read the obituaries in our local paper, I am shocked to see that most are about people much younger than I. Rural citizens unfortunately have a shorter lifespan because of ongoing and untreated chronic health problems. Diabetes, hypertension and mental illnesses can be treated (or sometimes even prevented) with adequate access to care.

Alabama must provide health care for women before they become pregnant. Support our floundering mental health services. Prevent incarcerations and overdose fatalities. Don’t let another rural hospital close.

And expand Medicaid to adults — it’s the right thing to do and the smart thing to do.

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Marsha D. Raulerson, The Anniston Star’s 2016 Alabamian of the Year, is a physician in Brewton.

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