Point of View

More to do on NC health care gap

April 7, 2014 

Let’s put our hands together for North Carolina. Among the 36 states that used the federal health care exchange, North Carolina came in third – with more than 200,000 residents enrolling in Obamacare as of last week’s deadline.

Should we now kick off our boots, rest our legs and lean back until open enrollment rolls around again next November? Not quite.

For every person enrolled in Obamacare in North Carolina, nearly two poor people who should have qualified were left without coverage. The Affordable Care Act was designed to provide health care access for every person living in poverty. But when North Carolina state legislators refused to expand Medicaid in March 2013, two groups fell into a gap: all poor childless adults and some poor families. As a result, in this state, every childless adult living in poverty is barred from help. Some N.C. families who should qualify are left out, too. Families of four making more than the state’s Medicaid cutoff of $10,000 but less than the federal poverty line of $23,500 receive no help with health insurance costs. So as we close the doors on open enrollment, let’s not forget the hundreds of thousands for whom the doors were never open.

As a health care policy student, I jumped on the chance to volunteer with Get Covered America, a national nonpartisan campaign focused on educating consumers about Obamacare. I wanted to help people in Durham understand how a momentous piece of legislation was improving access to health care. I went door-to-door raising awareness and connecting people with health care navigators trained in enrolling the public in Obamacare. Navigators are funded by federal grants as part of the Affordable Care Act’s outreach and enrollment program.

A young couple with a newborn welcomed me into their home to discuss their health care options. My job that day was to refer families with health care needs to navigators, not to ask about income or assess financial eligibility for Medicaid and tax subsidies. I crossed my fingers and hoped their annual income didn’t fall between $6,700 and $20,000, in which case the family would be in the coverage gap and left with nothing.

It didn’t take long for me to realize that many families were hitting a dead end.

In some cases, their frustration was loud and clear. These people felt misled by false hope. They were living in poverty and thought they might finally get some help accessing affordable health care. Instead, they discovered they had been irresponsibly triaged and left ineligible for financial assistance.

I spent the last two years in medical school learning how to deliver health care. I learned that not everyone with anemia gets a blood transfusion – you must have a Hemoglobin level below 7. I learned that not everyone with chronic kidney disease gets dialysis – you must have a glomerular filtration rate below 15. I learned that not everyone with a terminal disease is sent to hospice – you must have less than six months to live. Doctors use thresholds all the time to determine eligibility for treatment, but typically in a manner that provides treatment to those most in need.

What would the world look like if doctors delivered health care the way North Carolina is delivering access to health care? It would be ugly and scandalous. It would look like Memorial Medical Center in New Orleans after Hurricane Katrina.

When that happened, services were delivered to the well and the deathly ill, but not to some patients who could have survived with appropriate treatment. The result was preventable death and suffering. There was public outrage and even lawsuits against the providers who inappropriately distributed limited resources. I would certainly lose my job for practicing medicine so irresponsibly.

The current gap in health care coverage in North Carolina is just as deserving of outrage. So hold off on the applause and keep your boots on, because our job isn’t done yet. Let’s keep showing up for Moral Mondays so that in November, open enrollment in North Carolina is truly open to the 320,000 who were left out this time around.

Mark Dakkak is a Master’s in Public Policy and Medical Doctor student at Duke University. He studies ways health care systems can improve care for underserved populations.

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