Healthcare: It's Complicated

providing healthcare

While efforts to repeal the Affordable Care Act are behind us for now [as of this writing], and Congress is looking ahead at fixes to address increasing premiums and unstable insurance markets, we can all be certain of one thing when it comes to healthcare: the need for free clinics.

The American healthcare system is fractured. In order to access healthcare, you need to have health insurance. In order to have health insurance, you need to be able to afford it or get enough financial help in order to afford it. If you’re not able to afford it at all, you may qualify for Medicaid. If you’re over 65 or have a long-term disability, you may also qualify for Medicare. If you’re new to this country and don’t earn much money, you likely do not qualify for any program unless you’ve been here for more than five years, in which case you may be eligible for coverage. If your employer offers you coverage that’s affordable but offers your family coverage that’s unaffordable, then they too are probably out of luck.

Still with me? No? How about this:

The truth is, healthcare and health insurance in America IS complicated. The Affordable Care Act made great progress in extending coverage to millions who had traditionally been left out of the healthcare system, but it’s not perfect. And while we don’t have a coverage gap in Wisconsin, we do have an affordability gap. Low-income Wisconsinites in particular experience great fluctuations in their incomes on a month-to-month basis. In terms of health insurance, this means they move from being eligible for Medicaid to coverage on the Marketplace, and are frequently uninsured for short or long windows of time.

Thankfully, free clinics, like Share the Health Free Gynecology Clinic, exist and fill in the gaps left by our fractured healthcare system. Share the Health is a free gynecology clinic that operates thanks to the support of its partners, namely Madison Women’s Health, LLP and University of Wisconsin Hospital and Clinics, to provide gynecologic specialty care to underserved women, all the while training future healthcare professionals to serve their communities. While Madison has a strong network of health safety net providers, like Access Community Health Centers and Planned Parenthood, specialty care for uninsured populations is incredibly hard to find.

This is where Share the Health comes in. Here’s a realistic hypothetical situation: Share the Health’s team of volunteer providers and medical students see a 43-year-old uninsured woman who is referred by another provider for specialty care for abnormal bleeding due to a thickened uterine lining. Her condition is so bad that it impacts her ability to work regular hours; spend time with her aging and ailing father, for whom she grocery shops and sends daily medication reminders; as well as her primary role as a mom to two young children. An evaluation with a biopsy shows a precancerous change.

We can’t say for certain what her medical situation will be if we don’t see her, but we do know that regular excessive bleeding requires blood transfusions. Untreated precancerous cells found in the uterine lining often lead to uterine cancer, treated by hysterectomy and radiation.

She can only see us during evening hours because she has used up her limited sick time at work trying to manage her condition from home. If she misses additional work at a new temporary job, her employer would likely contact her agency to find someone who could more reliably work every day. She hasn’t yet found affordable insurance because her new job pushes her above the monthly income limit for BadgerCare. Luckily, her kids remain insured, but like many moms, she sacrifices her own coverage and puts her additional income toward household needs and professional caregiving for her father.

If her condition worsens, as it likely will, she’ll continue to put everything she cares about and all of her personal contributions to her family and community at risk. After evaluating the biopsy, Share the Health provides her with a prescription for monthly progesterone, which her referring provider can get for her at a discounted cost. We work with her primary physician to understand the need for continued progesterone until she reaches menopause to mitigate the risk of future cancer. And our student volunteers work with local enrollment partners to help her find an insurance plan on the Marketplace that offers her $213 in premium tax credits. It’s still a stretch for her financially, but she can make it work given her risk factors and a glimpse into what her life could look like with a treatable, but unmanaged health condition.

In order to access healthcare, you need to have health insurance. In order to have a healthy life, you need more than what health insurance can buy. Family, community, work, and a safe environment are all part of what makes us healthy, happy, and productive. Free clinics are a band-aid solution to an imperfect system, but the volunteer team at Share the Health is happy to do its part until we come together and truly tackle the root causes that have created these gaps in our community and disparities in the health of our community members. Sadly, our community is one of dozens in a state with hundreds of similar family stories with mom’s who wouldn’t get cancer if they could get the simple care that insurance allows. There is only one Share the Health in Wisconsin, and the other communities continue their struggles.

Mary S. Landry, MD, is president and cofounder of Share the Health Free Gynecology Clinic, Inc., and is a professor of obstetrics and gynecology at University Health Service Women’s Clinic at the University of Wisconsin–Madison.