I have known Opal for five years. In that time, her health has gone from not too good to pretty bad, but she is hanging in there. Or rather, she was hanging in there. Now, she's hanging by a thread. Who am I? No one. Just a family physician at a county clinic for the uninsured in Texas, one of the 24 states that refused the Medicaid expansion. Our governor did everything he could to make the ACA rollout a failure. But nevertheless, Opal’s husband works, and he makes just enough to qualify for care under the Affordable Care Act. Great, right? Having some insurance is always better than having no insurance, right?
Like many urban areas, my county funds a public clinic for the uninsured. We pay for necessary medications, surgeries. We do screening colonoscopies. We do mammograms and immunizations. If you have a heart attack, you can get your coronary artery stented. If you get cancer, you can get your chemo. No deductible, no caps, no pre-existing conditions exclusions and while there are some medication copayments, you can get them waived. We don’t want to see anyone die for lack of $5. Medicaid type health care, more or less, but with a higher income cap.
The Medicaid expansion would have taken over the cost of running the clinic. Since Rick Perry thinks he has a shot at becoming Vice President, he said “No” to billions of dollars. Therefore, taxpayers in our state's urban areas will continue to face double taxation---once to pay for health care for our own poor, once to pay for health care for the poor in the lucky 26 states that took the expansion. Tax payers in rural areas will continue to see their hospitals close and their doctors flee----but this is not about them. This is about Opal.
Opal and her husband were told that the ACA’s cheapest plan would allow its members to keep seeing their county doctors and getting the care they are used to receiving through the county. They were relieved. The cheap plan only cost them pennies a month out of pocket. The next cheapest plan would have cost them $100 a month---and people who live with chronic illness don’t have that much cash lying around. Once they signed on the dotted line, Opal and her husband learned the truth. Opal now had insurance that had an enormous deductible. Her insurance would cover care only if it was prescribed by a tiny handful of providers---anyone who believes that HMO provider directories are accurate has obviously never dealt with an HMO. Anyone who believes that the people who sign you up for an HMO tell the truth has never encountered an HMO rep. They are paid for one thing---your signature.
Opal needed her medication. Her medication cost $500. Opal did not have $500. Opal had not met her deductible. Her $5000 deductible. Opal had a heart attack. Opal went back to the county hospital. She is getting care again with her county doctors. Too bad it was that last little bit of her heart that she could not afford to lose. I wish you could hear the fluid in Opal’s lungs when she breathes. I wish you could see the fear in her eyes as she faces her mortality.
You can make some things right, after they get messed up, but you can’t put back dead myocardium or restore a dead kidney or replace infarcted brain. Yes, I love my party. Yes, I want to see it do well in the elections this fall and in 2016. But I am not going to keep my mouth shut and watch Opal and people like her get sick and die, because the ACA has as many holes in it as the god damned Titanic, and the GOP and the SCOTUS and the Tea Party are exploiting every last one of them.
So, if you want to go back to circling the wagons around the ACA, insisting that everything is just fine, go right ahead. You can even accuse me of not being a Family Physician and of not working with the chronically ill and uninsured. But if you try to accuse me of being a Bad Democrat, of not supporting the President, because I won’t keep my mouth shut, I have to ask:
What kind of Democrat would ask another Democrat to keep quiet about the suffering of the chronically ill? No Democrat, that’s who. The only folks who hate the chronically ill are the bean counters of the private health insurance industry. And they will do whatever it takes to make sure that sick folks who make the mistake of signing up for their insurance plans get the hell back off---assuming that they don’t die first. And that is no exaggeration. Though Opal’s name has been changed, for reasons of patient confidentiality. The fluid filled lungs, her fear, my anger---they are all real.