As I trolled various discussion boards, with members’ stories warning of blindness and corneal transplants, I panicked and started calling around for an appointment. This must be what drives my patients into that full panic state when they come in the ER at three in the morning.
In 2015, experts estimate that 20 million more non-elderly Americans will be minted into newly-insured patients. But while much of the current debate surrounding the Affordable Care Act has been around the cumbersome website, the controversy of having to trade in one’s current health insurance, the true affordability of monthly premiums, and the potential low ratio of primary care physicians to new patients, there may also be other unforeseen issues. Namely, will these newly-insured patients be able to navigate this complicated—and still expensive—healthcare terrain? Even being a supposed “insider,” I had limited membership.
Many phone calls later, plus several attempts at booking through an online site, as well as an erroneous visit to a laser eye clinic well-concealed as a comprehensive eye center, I was getting nowhere. Surrendering, I finally called the cornea specialists at the academic hospital where I worked and explained how I was a physician there and needed to be seen immediately.
I know how lucky I am to be a patient who happens to also work in the healthcare system. I was able to diagnose myself, start treatment on my own, and get squeezed into an appointment when everywhere was booked. But in many ways, I certainly felt more like an outsider. Even after starting treatment and seeing a top eye specialist, it still wasn’t easy or cheap. Initially, I had to use antibiotic drops every hour. But my insurance would only cover one three-milliliter bottle every three weeks. Each bottle not covered by insurance cost me $130. I was also supposed to see the eye doctor daily in the beginning, then weekly. Each visit cost me $35. Between the appointments and the medication, by the time I was finally labeled “cured,” I had spent nearly $800 in out-of-pocket expenses for a relatively small health issue.
My own experience makes me fear that for many Americans, health insurance may not necessarily equal health care. Access and cost will still remain barriers—and can be difficult to surmount for many. The pioneering Oregon Health Insurance Experiment, which is the first time the impact of Medicaid has been evaluated using the gold standard of a randomized controlled design, may foreshadow many of these hurdles to come once the ACA is fully implemented.
In 2008, by using a lottery system to select nearly 30,000 qualifying people for admission into its Medicaid program, the state of Oregon was able to generate data on the effects of expanding public health insurance to low-income, previously uninsured adults. The latest results are quite revealing. Notably, Medicaid actually increased ER visits classified as "non-emergent," "primary care treatable," and "emergent, preventable." Furthermore, there was no difference between these visits occurring during standard workday hours—times during which doctors’ offices are open—and during weekends and evenings.