Dear Editor;

Regarding the letter from a Bill Hunt, “Debunking Rep. Bruce MacDonald,” in which the writer cites a study done in Oregon that showed emergency room visits increased when low-income people were given access to medical insurance, I would make a few points.

First, the idea is that this coverage is extended to low income people and their families. (The federal poverty level income for a single person is $11,490 a year, and for a family of four, $23,550 a year.)

Indeed, the Oregon study of 10,000 randomly chosen low-income people does show an increase in the early stage (two years) of increased usage of emergency rooms in Oregon when they got Medicaid health insurance. I grant Mr. Hunt that point.

Mr. Hunt fails to mention a set of studies from Massachusetts, which show that emergency room visits have declined in that state as healthcare insurance has been extended to the entire state. The Massachusetts studies are longer than the two-year Oregon study.

The changes sought by making healthcare available to low-income people will not occur overnight. Consider that most low-income people without insurance have almost certainly seldom or never been to a doctor for regular care. They don't have doctors because without insurance, they can't afford them.

It appears that when they get insurance, they increase the use of the healthcare system as they know it. They use the emergency room more. That's what the Oregon study shows. Just because low-income people get insurance, does not mean that they have a doctor to see. To change this outcome, low-income people will need more help in finding family physicians who will take them on under Medicaid. We also need more family physicians.

We need more time to see the lifetime benefits of people having access to medical insurance. Over time, as newly insured people are guided to the most cost effective means of ensuring their long term health, there will be more use of family doctors, and less use of emergency rooms, as the Massachusetts example shows. This will be a major positive change, but it will not happen overnight.

Rep. Bruce MacDonald
Boothbay