An Interview with Dr. Madeline Eckenrode

The U.S. healthcare system is broken in many ways, leaving millions of Americans un- or under-insured and unable to access the care they need. This is especially true in states like Alabama that have not expanded Medicaid under the Affordable Care Act. In an eye-opening interview on the Taproot Therapy Collective podcast, hosts Joel Blackstock and Haley Beech speak with Dr. Madeline Eckenrode, a primary care physician at the University of Alabama at Birmingham (UAB), about the challenges patients and doctors face navigating a dysfunctional healthcare bureaucracy.

The Impact of Being Uninsured

Dr. Eckenrode, who recently penned an impactful op-ed on the importance of Medicaid expansion, sees the devastating effects of lack of insurance every day in her practice. She treats many young adults with complex chronic conditions who lose Medicaid coverage at age 19 if their parents don’t have a qualifying private plan. Without the safety net of Medicaid to cover preventive care and medications, their health drastically declines – until a crisis lands them disabled and back on Medicaid or Medicare. It’s a vicious, costly cycle that could be mitigated by expanding coverage.

“I just see it so clearly when people are able to get on reliable insurance and get that primary care and get their chronic conditions treated like it’s an intervention that is so impactful,” says Dr. Eckenrode. “It’s not perfect, but it’s so much better than nothing.”

The Flaws of Profit-Driven Healthcare

A major focus of the discussion is how profit-driven private insurance companies make it exceedingly difficult for doctors to deliver appropriate care. Dr. Eckenrode describes regularly spending hours on the phone fighting to get basic generic medications covered and crying with insurance reps begging them to approve life-saving treatments.

Patients need a referral and prior authorization for services as basic as physical therapy after an injury. The insurers’ goal seems to be to wear down doctors and patients with red tape until they give up. In contrast, Dr. Eckenrode notes that in her experience, Medicaid tends to have solid prescription drug coverage without requiring onerous prior authorizations for long-established medications.

The Economic Case for Medicaid Expansion

Expanding Medicaid is both economically pragmatic and morally right, as ample data from other states shows it improves health outcomes while reducing overall costs. Without insurance, people end up in crisis, utilizing high-cost emergency services. Paying for prevention up front is much more cost-effective than paying for organ transplants and dialysis down the line when chronic diseases spiral out of control.

Dr. Eckenrode argues that working people in jobs like food service deserve access to Medicaid so they can stay healthy and keep contributing to society and the economy. Her brother is a prime example of someone whose life was saved by accessing recovery services through Medicaid and is now thriving.

“It’s like, why don’t we want everyone to have that safety net of insurance coverage when they need it to help them stay healthy, get healthy, and then hopefully one day, get jobs that have employer-sponsored healthcare,” she notes. “But not everyone can do that. A lot of people can as long as they have a little bit of help through vulnerable times.”

The Politics of Suffering

The problem, as the group discusses, is that Alabama politicians seem more interested in scoring points with divisive national issues than actually improving life for their constituents. There are some hopeful signs though, like the state legislature recently expanding Medicaid coverage for new mothers to 12 months postpartum and making it easier for pregnant women to enroll. Small victories matter in the long fight for reproductive justice and health equity.

The Power of Grassroots Advocacy

The key takeaway is that healthcare providers and regular citizens need to speak up and get engaged at the local and state level to effect change. Supporting organizations like Alabama Arise that advocate for expanding access to care is one powerful way to make a difference.

We can find common ground in reducing the grocery tax and other regressive policies that hurt struggling families. Change is possible if we organize around issues close to home that matter in people’s daily lives. As Dr. Eckenrode notes, calling state legislators about key bills and making your voice heard does lead to progress, even if it feels incremental.

“I would just encourage people to not be hopeless and to get engaged with more local or state-based organizations,” she says. “Just learning about bills that are in the statehouse, calling your legislators… it feels really good to be civically active and you can turn the needle.”

Conclusion

This interview is a bracing wake-up call about the harsh realities faced by un- and under-insured Alabamians and the providers striving to care for them despite a system stacked against them. Dr. Eckenrode makes an ironclad case that expanding Medicaid is the fiscally smart and morally right path forward.

For those moved by her message, the next step is clear: get informed, get engaged, and relentlessly advocate for change. Everyone deserves access to affordable, quality healthcare. In the richest country on earth, settling for anything less is unconscionable.