Arjun Prabhu
Healthcare in Underserved Populations Essay
As recently as 2013, 18% of Americans were uninsured, the majority of
whom come from households that earn less than $36,000 per year.1 Essentially
priced out of primary care, where do the uninsured turn to for healthcare? One
option is free health clinics such as the Birmingham Clinic on Pittsburgh’s South Side
neighborhood. Nestled behind the 10th Street Bridge, the Birmingham Clinic is a
community partnership between the Program for Health Care to Underserved
Populations and the Salvation Army that serves uninsured and medically vulnerable
groups by utilizing an exclusively volunteer group of health care providers.2
During my medical school rotation Health Care in Underserved Populations, I
have had the privilege of helping to serve patients at the Birmingham Clinic. One
encounter particularly stood out to me. Leslie is a 58-year old woman with
congestive heart failure, uncontrolled hypertension, and hypothyroidism who
presented due to nausea and bloating after taking her thyroid medication
levothyroxine which has prevented her from taking it as directed. As I was obtaining
her medical history, she expressed how her health problems frightened and
overwhelmed her, leaving her in tears. She told me how she works two janitorial
jobs, but has trouble making ends meet. When the Affordable Care Act was passed,
she was hopeful she would be able to get healthcare but was told that she did not
qualify for Medicaid and soon found that she could not afford the marketplace
premiums. After conferring with my attending, we decided to add another
medication to help lower her blood pressure and she agreed to try taking her
levothyroxine before bed. Still, because it is more difficult to coordinate follow-ups
at free clinics due to high demand for appointments and more limited availability of
medications and testing due to cost, if Leslie had had a primary care physician,
perhaps her medical problems would have been better controlled to begin with. The
fact that she did not qualify for Medicaid and could not afford the marketplace
premiums bothered me.
On March 23, 2010, President Obama ushered in the first true overhaul of the
US healthcare system since the passage of Medicare and Medicaid in 1965. The
Patient Protection and Affordable Care Act, or “Obamacare,” was enacted with the
goal of increasing the quality and affordability of health insurance, lower the
uninsured rate by expanding public and private insurance coverage, and reduce the
costs of healthcare for individuals and the government. And the Affordable Care Act
has been largely successful, so far.3 The US uninsured rate has dropped to 12.9%,
highlighted by drops among African-Americans and lower-income Americans, and
Gallup found that most newly insured Americans plan to renew their policy or get a
new policy while more than half of those who are uninsured plan to sign up.4
Additionally, since implementation of the Affordable Care Act, healthcare cost
inflation has dropped, of which the Act is likely to have contributed to.5 Requiring
insurance plans to cover contraception at no cost to women has reduced out-ofpocket spending on most major birth control methods by an estimated $1.4 billion
in 2013.6
Despite all its successes so far, the Affordable Care Act has left people like
Leslie, who work hard and earn “too much” to qualify for Medicaid but not enough
to afford the marketplace premiums, out in the cold. Luckily for her and others in
Pennsylvania, the Commonwealth’s Medicaid expansion will go into effect this fall,
meaning that many people who are in Leslie’s position will soon qualify for
Medicaid. Still, in 2016, nearly 20 states will still be without Medicaid expansions. As
the successes of the Affordable Care pile up, I believe it is time for every US state to
pass the Medicaid expansion and provide more Americans with what seems like a
basic human right: primary health care.
Levy, J. In U.S., Uninsured Rate Sinks to 12.9%. Gallup.
http://www.gallup.com/poll/180425/uninsured-rate-sinks.aspx. Accessed 9 July
2015.
2 The Birmingham Free Clinic, South Side. Program for Health Care in Underserved
Populations, University of Pittsburgh.
https://www.dom.pitt.edu/dgim/phcup/clinics.html. Accessed 9 July 2015.
3 Pear, Robert. Health Law Critics Prepare to Battle Over Insurance Exchange
Subsidies. New York Times. Accessed 9 July 2015.
4 Levy, J.
5 Assessing the Effects of the Economy on the Recent Slowdown in Health Spending.
The Henry J. Kaiser Family Foundation. http://kff.org/health-costs/issuebrief/assessing-the-effects-of-the-economy-on-the-recent-slowdown-in-healthspending-2/. Accessed 9 July 2015.
6 Tavernise, S. After Health Care Act, Sharp Drop in Spending on Birth Control. New
York Times. http://www.nytimes.com/2015/07/08/health/after-health-care-actsharp-drop-in-spending-on-birth-control.html?_r=0. Accessed 9 July 2015.
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