Two Stories Illustrate Why We Need the Affordable Care Act

Today’s Managing Health Care Costs Indicator is $36,000

Statistics and facts are fine –and we should have evidence-based health care policy

But sometimes we need a story to remind us what’s at stake as we debate providing access to health care to Americans.  Today, I have two stories.

I heard from a colleague last week. Her parents are retired, and her dad is eligible for Medicare. But her mom is under 65, and therefore not yet eligible for Medicare.  Her dad’s company terminated retiree health coverage, and her mom as a diabetic in her early 60s couldn’t purchase meaningful health insurance.  She went on a diet and stopped taking her diabetes medicine. She was just admitted to the hospital for slurred speech and weakness, and has progressed to have a left sided stroke.   

This is a failure on both a clinical and a financial level. Her physicians didn’t realize that she couldn’t afford the medications – and probably didn’t focus on using cost-effective generics. So she wasn’t taking her diabetes medications. Even if the high blood sugar didn’t cause the stroke, it’s a risk factor for poor outcome.   The cost of this hospitalization will likely be a terrible financial blow to her family.   I don’t know what her neurologic impairment will be.  I don’t know that if she had full health care coverage she would have had a better clinical outcome. But there is plenty of evidence that those with health insurance fare better when they have major medical problems. 

The free unregulated market simply can not and will not offer affordable health insurance to diabetics in their 60s.  It will take well-regulated health insurance exchanges to make insurance affordable for those who already have significant illness.  If she lived in Massachusetts she could have purchased a health plan through the exchange. If it were 2014 and her state had implemented an exchange she would have been able to purchase a health plan that would have cost no more than three times the cost of a plan for a younger, healthier patient.  But she lives in a state where the governor opposes the Affordable Care Act and  has frozen efforts to establish an exchange.

I’ve also heard from a physician colleague who suffers from a progressive neurologic disease.  He’ll soon have to go on disability despite his youth, and tells me his health insurance bill for a family plan will be $36,000 per year.  He and his family will spend over half of their anticipated future income on health insurance, and that doesn’t count out of pocket health care expenses (usually another 20+%).  Although he’s worked as a physician and a physician executive for his entire career, he and his family have no health security, and could be impoverished by his illness.   The bright spot for him is that if he is fully disabled he will become Medicare eligible after a waiting period – and his family can then purchase a much less expensive health plan.  Of course, the Ryan plan would replace the certainty of Medicare with the risk of vouchers likely to be of less value than the cost of private insurance – especially for those with significant illnesses.

My colleague’s comments on the state of health care access for those with significant illnesses:

Health care systems reflect the culture of the particular country – and this way of treating the poor and sick is nothing less despicable than the race and gender discrimination we officially tolerated for so long.  We now officially despicably tolerate healthcare access disparities based on wealth and sickness.  The concept of ignoring the sickest and most unfortunate in our society with regards to health care seems neither morally nor financially sustainable.