Dr. Pradeep Arumugham of Kinston is a heart doctor who doctors from the heart. The cardiologist takes whatever his uninsured patients can afford, and they all want to pay something. Recently he accepted payment in bundles of sweet potatoes.

Arumugham (pronounced ahh ROO-moo-gum) could make a fine living in a big city, and he’s had offers. But there’s a friendliness about Eastern North Carolina that surprised him and now makes him want to stay and serve.

“I do like Eastern North Carolina because the people are very nice,” he says. “Walking the streets, people say, ‘How are you?’ I used to think – who are they talking to?”

But beneath the doctor’s affection and dedication, anger smolders. He’s angry that lawmakers in North Carolina refuse to expand Medicaid. Every day he sees the toll of that refusal. People suffering with chronic conditions because of lack of access to scans or specialists or devices such as pacemakers.

I became aware of Arumugham when he sent The News Observer a letter that had started as a Facebook post. It told of a patient who had died for lack of a pacemaker that she could have received if Medicaid had been expanded. The article and the woman’s story drew a powerful response. Curious, I drove east from Raleigh to see this medical missionary of the Coastal Plain.

Arumugham, 41, who is from the south India state of Kerala, argues for Medicaid expansion before any group that will listen. He discusses it with other doctors and community groups. He tells them that providing access to health care isn’t a handout. It’s an obligation.

“I’m not talking about giving (the uninsured) money. I’m saying, ‘If you get sick, I will care for you,’ ” he says, and then he asks, dumbfounded, “What is wrong with that?”

A report from the Cone Health Foundation in Greensboro estimates that roughly half a million North Carolinians would gain health insurance if Medicaid was expanded, with at least 90 percent of the cost being paid by the federal government. Thirty-one states have expanded Medicaid. By not expanding, North Carolina is forgoing billions of dollars in federal money. If it remains among the holdouts until 2020, it will have lost $21 billion in federal money and 43,000 jobs, the report said.

Arumugham prepared for my visit by calling in some of his patients who are dangling in the void where Medicaid expansion should be.

There was Shelton, 48, a truck driver struggling with congestive heart failure. It’s a family condition. His sister and brother died from it the same day. He can’t walk for more than 15 minutes without having to stop. He needs a defibrillator that will cost more that $50,000, and he should be evaluated for a heart transplant.

Arumugham says Shelton’s advanced problems could have been avoided if he had had earlier access to a doctor and proper treatment. Now he’s waiting to qualify for Social Security disability and relying on family members to pay for his medicine. Shelton says, “Sometimes it hurts as a grown man that you have to ask somebody for help.”

In another room is Sandra, 53, the manager of a local bingo hall where she makes $9,000 a year. She has asthma. When she has a bad attack, she goes to emergency room and is put on a ventilator. Most of her money goes to pay for an inhaler and medicines. If she could get on Medicaid, she says, “It would mean a whole lot.”

Charles, 64, once worked repairing tractors but quit because of a bad back. He had a heart attack in 2007, and bypass surgery. Then he suffered a stroke in 2011. He needs to see a specialist for a catheterization, but he can’t afford the cost of more than $7,000.

Across North Carolina, this hidden agony goes on for no acceptable reason. People who worked all their lives suffer with conditions that could have been prevented or could be resolved with treatment. But the health insurance that would give them access to medical care is being withheld to make a political point.

One doctor’s empathy and charity are not enough. Patients’ conditions often call for care he can’t provide and surgery, medicines and medical devices no working person can afford. Yet he continues to open his door to people whom state leaders have shut out. Those he can’t cure, he consoles and campaigns for the state to give them the access to the health care they need.

“I want to make a difference; that’s all that matters,” he says. “When I die, I want one thousand people to say, ‘He helped me.’ ”

No doubt the tireless, idealistic doctor will reach that number and more. But what of the uninsured who die needlessly after years of pain and worry that they could have been spared? They may say in their last hours of those in power in Raleigh, “They wouldn’t help me.”

Their numbers, too, will be more than a thousand.

Barnett: 919-829-4512, nbarnett@newsobserver.com

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