ER doctor welcomes reforms, cites desperation of uninsured

There's very little down time in the emergency department at UNC Hospitals, where more than 68,000 people will be treated this year. Dr. Charles Cairns, who heads the unit, says only about 10 percent will have minor ailments that don't warrant the immediate, heightened attention of emergency medicine.

Still, they go to the emergency department, an expensive portal into the health care pipeline, because they often have no insurance, and therefore have no other entry point. A third of patients at UNC Hospitals have no insurance.

In addition, many thousands of those who are desperately sick could have avoided the emergency visit if they had received routine care, Cairns says. Diabetes, asthma, high blood pressure - all can be well-managed when patients see their doctors regularly. But without insurance, many ignore their health until it reaches a crisis point.

Cairns says the new law has the potential to ease this traffic in his busy department.

"Any reform that enhances access to care is welcome," Cairns says.

But crowding is likely to worsen before it gets better, he says. With more people covered by health insurance, primary care doctors will be stretched thin, and reliance on emergency departments may spike. That's a situation that occurred in Massachusetts, which has blazed trails toward universal health coverage.

"We're one part of the system that absorbs changes," Cairns says.