When health becomes a factor in paying bills

By Dennis Archambault

“I can’t pay my taxes!…”
– Marvin Gaye

Marvin Gaye’s exasperation in “Inner City Blues,” a generation ago, is sadly relevant today as households need to come to terms with which bill to pay and when. Or which not to pay and what are the consequences? Is it the heat bill? The cell phone bill? The rent or mortgage? The car note? Water bill? Assuming the best money management, many working class households face this stress every day. Decisions may be made rationally or irrationally, and with those decisions come consequences.

Utilities like water and heat are essential to life. But they are considered services for which consumers are responsible to pay. There a population – likely served through the Healthy Michigan expanded Medicaid program, but also including some of the lower income levels in the commercial insurance market – that is making choices about which bills to pay. Those choosing to not pay their water bill find ways to get by – borrowing water from friends and family, buying bottled water, and likely not having enough for proper hygiene or hydration.

Prolonged absence of regular access to clean water results several public health concerns, according to
Dr. Wendy Johnson, a public health professional who directs La Familia Medical Center in New Mexico, weighed in on the Detroit issue at a news conference recently:
• Dehydration, which causes a litany of problems, specifically for elderly and young people and those with chronic diseases.
• Poor hygiene, which can help spread and create water-related problems like the skin disease MRSA, as well as various GI issues.
• Unhealthy choices that can cause other health problems. If someone is without water, he or she cannot cook, which means he or she is eating cheap fast-food and drinking sugary beverages, which are less expensive than bottled water.
• Mental health issues. For example, she said, the inability to bathe negatively affects one’s sense of self-worth, as well as the ability to concentrate at school or work.
• Ripple effects; many of the water-borne diseases are contagious.

The Population Health Council has taken a clear position on this issue as being consistent with the federal commitment to providing a level of health care for a level of society struggling with the effects of poverty. Access to water should be provided for populations served through the Medicaid program, not as a consumer service.

Payment assistance, funded through philanthropic funds, may seem compassionate and appropriate, but philanthropic priorities change and demand will increase during economic downturns. Beyond the practicality of charity, it comes down to a systemic argument: Can a society afford to underwrite the cost of water service in a managed access system like Medicaid? And if so, should it?

Dennis Archambault is vice president, Public Affairs, Authority Health