McClatchy-Tribune Information Services/MCT,
‘Public health catastrophe’
“Lack of insurance can be lethal, and we believe our professional community should treat inaccessible coverage as a public health catastrophe and stand behind people who are at risk.”
Dr. MICHAEL STILLMAN and Dr. MONALISA TAILOR in a Nov. 14 New England Journal of Medicine article
ACA can help prevent 'Dead Man Walking' stories
- Article by: Editorial Board
- Star Tribune
- November 22, 2013 - 5:53 PM
The usually dry pages of the New England Journal of Medicine recently offered a riveting reminder that there’s a price to be paid when debate over the Affordable Care Act tilts heavily toward its flaws and away from its potentially lifesaving benefits.
“Dead Man Walking” was the headline on the Nov. 14 article in the prestigious publication. In it, two Kentucky physicians relay the heart-rending account of a “Mr. Davis,” a “U.S. citizen who will die because he is uninsured.’’ For privacy reasons, the doctors did not use their patient’s real name.
Mr. Davis and his wife both worked full-time but were chronically without health insurance, falling into the treacherous gap that the Affordable Care Act (ACA) aims to help people out of. They made too much to qualify for public medical assistance but not enough to afford coverage on their own.
A year before the doctors saw him at their clinic for the poor, Mr. Davis sought medical care for symptoms suggestive of colon cancer. He was told at that time that he needed “adequate insurance” for a full evaluation.
He couldn’t afford coverage. He bore the weight loss, growing pain and indignity of this fearsome disease for a year before finally going to the clinic. It was too late. The cancer was widespread, and he chose to forgo treatment, uttering on his own as his wife sobbed that he was a “dead man walking.’’
While it can’t be proved conclusively that having health insurance would have saved Mr. Davis’s life, timely evaluation and treatment certainly would have given him something he never had — a fighting chance. As criticism mounts over the ACA’s rocky rollout, his plight is an important reminder of why it’s important to take the long view when it comes to this landmark law.
There shouldn’t be suffering like Mr. Davis endured in the world’s wealthiest, most technologically advanced nation. If the ACA is given a chance to work, as the Medicare Part D prescription drug program was during its troubled launch, the coverage gap that Mr. Davis fell into will substantially narrow and perhaps close eventually as the law is improved.
Lives lost now because of a lack of medical coverage — the medical journal articles estimates the toll at 45,000 adult deaths a year — could be saved. Those who argue that the old health care system was fine don’t understand the deadly consequences of being a “medical have-not.” Or, even worse, they don’t care.
But Mr. Davis’s case is noteworthy for another reason. During his appointments, it became clear to his doctors that he didn’t realize how the ACA could help his family. Instead, he worried aloud about the law’s mandate to buy health insurance, which begins in 2014, and about the tax penalty for not having coverage.
What he didn’t realize is that under the law’s expanded eligibility for Medicaid, a federal-state program for the poor, his family would qualify for the program, according to the article. That would give them “access to affordable and comprehensive care.’’
Disturbingly, Mr. Davis’s physicians said that many of their other poor and uninsured patients suffer similar misconceptions about the ACA’s benefits. It’s a good bet that patients in Kentucky aren’t the only ones afflicted by this.
That’s a key reason a new analysis from Families USA deserves a spotlight. The organization is upfront about its support for the health reform law. But its work also drew accolades this week for crunching data to offer critical context on the insurance policy cancellation uproar — which involves people who buy on the individual market — that has misleadingly suggested that the law is hurting more people than it helps.
The analysis reminds readers what a narrow slice of the insurance market is affected — about 5.7 percent of Americans under 65 buy coverage on their own. Of that group, 71 percent “have incomes at or below 400 percent poverty,’’ meaning that most of the people in this group meet income eligibility guidelines for the ACA’s new tax credits to buy better insurance or qualify for even more affordable coverage through the Medicaid expansion.
But one helpful analysis isn’t enough to overcome the myriad misconceptions about the law. While technical experts work around the clock to fix the troubled HealthCare.gov website, President Obama must convene the nation’s top marketing experts and figure out how best to reach the people who will benefit the most from the ACA. A law that aims to fill a coverage gap is suffering from technical glitches, but also from an alarming information gap in need of a cure.
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