La reforma

Today was the primary election in Massachusetts, which I technically voted in last week (fun fact: I have voted absentee for every election since I turned 18).  I'm not going to lie: I'm starting to get nervous about the political state of our country.  More specifically, I'm worried about health care and immigration.  I guess that should be of no surprise, since I'm working in a clinic that tries to provide better access to health care, predominantly for immigrants.

Health care reform passed on March 21, which was conveniently the day after my birthday.  I was super excited because it was the result of several decades of debate and it gave President Obama a lot of momentum.  However, at the time, the most obvious flaw in the plan to me was that undocumented immigrants would be completely left out.  I hoped this would be addressed if comprehensive immigration reform was brought up, but that still remains to be seen.

Living in Georgia has opened my eyes to another glaring problem with health care reform: providing more people with Medicaid is not going to help people living in rural areas.  In a lot of places in this state (and many others around the country), there simply are not enough doctors.  And the doctors that are in the most remote places often will not accept Medicaid or Medicare because the reimbursement is slow and the rates are extremely low.

I heard this criticism while I was in Philadelphia and in southeastern Massachusetts, but I kind of ignored it. I just assumed the doctors were being greedy. After all, I've spent my entire life living in areas that, quite honestly, have more doctors than we know what to do with.  On my Appalachian Experience trips in college, I learned about lack of access to medical care in rural West Virginia, Kentucky, and Virginia, but I didn't realize that the problem went beyond having a large number of uninsured people.

Now I hear people in this area who have good, private health insurance complaining about a lack of doctors, especially a lack of specialists.  I also have many individuals call me who have Medicaid but who can't find a doctor to see them.  In most rural sections of Georgia, the majority of people are poor and will probably qualify for Medicaid in 2014 (if they don't already have it), but doctors often cannot even "break even" if the majority of their patients have government-sponsored insurance.  I have no idea how more doctors will ever be enticed to set up practices in these places, either.  At least the funding for the National Health Service Corps has increased...

To be honest, health care reform really only affects about one-third of the patients at Good Samaritan.  Other free clinics around the country are worried about having to shift to serving the "underinsured", as well as covering eye and dental services (which were not included in health care reform at all but are very severe needs for many).  But at my clinic, I just pray that some of our patients will get better access to health care as the years unroll, and that the election in November doesn't set us back anymore.