By Wendy Wolf, MD, MPH
The young man sitting on the exam table before me was breathless, pale and distressed. We had never met, but he asked for me at the clinic desk. Staff at another hospital where he had received care for nearly 20 years gave him my name when they saw he was uninsured.
Despite having a significant congenital heart condition, he had been reasonably healthy. Married, with two children, he was an independent plumber. It provided a decent living but not enough to be able to afford insurance — even if he could have qualified for coverage. With his pre-existing condition, no insurer would accept him.
For years he did what people who are uninsured do — defer regular doctor visits and hope he was lucky enough nothing bad happened. But his luck ran out. Now he was unable to work and could barely walk.
After receiving a new heart valve, he returned to his business, pledging to pay what he could for his care.
Hospitals see lots of “charity cases,” but it’s become harder and harder to balance margin with mission to care for the increasing number of uninsured. The most recent Census (2012) found 48 million Americans were effectively shut out of our health care system because they lacked basic health insurance coverage.
As the public (and political) furor over the Affordable Care Act failings dominate the headlines, it’s important to keep perspective about what this complicated health reform law is trying to accomplish. There are some real problems, but there are many things Obamacare is doing right.
For the young plumber who couldn’t qualify for a health plan, under Obamacare, insurance companies can no longer turn him away, even with his pre-existing condition. Now, health plans must offer coverage to everyone who applies.
As part of the ACA, he could now qualify for lower cost (or even no cost) monthly premiums if his plan was purchased through the new Health Insurance Marketplace. Under Obamacare he might qualify for financial assistance if his annual earning was under $94,200 (for his family of four). Such financial help could finally put health insurance coverage within reach for his modest income.
Now, when someone signs up for health insurance, Obamacare requires that the plan provide a standard set of benefits that we all want to have in our plan. Most importantly, there are no out-of-pocket costs for people to get early, preventive care that can detect problems early on so patients can avoid more significant illnesses and treatment costs.
Currently, the media is focusing on the “outrage” of the public at the administration and federal agencies that failed to adequately oversee the development of the Health Insurance Marketplace ( www.HealthCare.gov) and the rollout of some provisions of the law. However, I suspect much of the public anger is a reflection of the intense anxiety that millions of uninsured and underinsured Americans feel as they are confronted by yet another barrier to finding affordable health insurance for themselves and their families.
Recently, people who couldn’t afford health insurance were asked to use one word to describe how being uninsured felt. Overwhelmingly they said, “Scared.” Scared about not getting care when they needed it. Scared about medical debt that could bankrupt families. Scared about being unable to afford a prescription or recommended therapy.
Their fears reflect the reality of how being uninsured effectively shuts people out of our health care system. In 2013, a new Commonwealth Fund study found that more than a third of adults in the U.S. went without recommended care, did not see a doctor when they were sick, or failed to fill prescriptions because of costs.
Yes, the marketplace website rollout was a debacle — but it is making steady progress so that Maine people are finally getting enrolled. Yes, dealing with the cancellation of existing policies that people hold will require the thoughtful action of policy makers to address their concerns.
However, 75 percent of Americans agree that our health system needs to undergo fundamental changes or be rebuilt completely. Despite its shortcomings, Obamacare is still the best starting place for that change.
Given a chance, it can remove the fear from the daily lives of more than 130,000 of our neighbors, friends and workers across Maine who are anxiously awaiting their chance to get affordable coverage.
This article originally appeared in the Bangor Daily News on November 24, 2013.
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