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Letter to the Editor: ACA Cuts Uninsured, but Leaves Financial Barriers

doi: 10.1097/01.EEM.0000450857.00346.a9
Letter to the Editor


I share Dr. Edwin Leap's frustration about caring for Medicaid patients who do not pay anything for their care. (“The Toxicity of Medicaid,” EMN eNews, April 8, 2014; I am exasperated when they ask for a prescription for their child's acetaminophen when Mom's purse or Dad's shirt pocket bulges with a pack of cigarettes that costs more than Wal-Mart acetaminophen. We shall always have patients such as these.

I am far more frustrated, exasperated, and angered that so many more of my patients are abandoned to fend for themselves by our profits-first health care system. These uninsured patients are good Americans; they work hard serving my family at restaurants, at Wal-Mart, and fixing our cars. They deserve care.

Yet I know they won't get it. Once discharged from my ED, I know they won't be able to get ongoing care for their hypertension, diabetes, and arthritis. They will live shorter, sicker, and less happy lives. They deserve better. The Affordable Care Act will cut the number of uninsured by perhaps 50 percent at best while leaving in place very high financial barriers to care.

A just published study from JAMA confirms that our system abandons uninsured and Medicaid patients. Eighty-five percent of privately insured patients were able to secure a timely appointment with primary care physicians. Only 58 percent of Medicaid patients were able to see a primary care doctor. Frankly, 58 percent follow-up for Medicaid seems substantially higher than what my experience suggests. For those self-pays with limited resources, only 15 percent were able to get a primary care appointment. (“Primary Care Access for New Patients on the Eve of Health Care Reform” JAMA Intern Med 7 April 2014.)

It is OK for some persons to have bigger televisions than others, OK for some to have nicer cars. It is not OK for good folks to suffer and die because they are less “successful” economically. Health care is a human right. I am blessed to work in the ED, the one place where ideally we do care for all.

Brad Cotton, MD

Circleville, OH

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