Much ink, airtime and digital bandwidth has been expended on the loss of health insurance, either through the termination of the ACA health care premium subsidies or the changes to Medicaid contained in last summer’s tax bill. Millions are either spending more for insurance or being forced to forego it altogether.
But underlying the affordability issue is one that’s equally or maybe even more insidious – the issue of health care availability. By availability, I mean having the doctors, health clinics and local hospital here in Rockbridge County where people can get to them, and having enough providers to treat people promptly when they need it.
Over the past 25 years, Rockbridge County has seen an increase in the availability of local medical services. Augusta Health expanded both its primary care practice and opened its multi-specialty clinic north of Lexington. Carilion also expanded the local availability of its specialty practices and opened VelocityCare, the area’s first, and as of now only, urgent care center.
The Rockbridge Area Health Center evolved from the Rockbridge Area Free Clinic serving mainly the uninsured into a Federally Qualified Health Center, which serves anyone regardless of need with medical, dental and behavioral health services. Its mobile dental and medical units take health care out into the remote area to meet patients where they live.
Much of this growth has been due to the greater access to health insurance through the Affordable Care Act, or Obamacare. Virginia’s expansion of Medicaid has also fueled this growth. These changes allowed many hundreds of Rockbridge County residents to get regular medical care, many of whom never had that in their lives. It helped cut down on emergency room admissions of sick people at Carilion Rockbridge Community Hospital – people who wouldn’t have gotten so sick if they’d been able to see a doctor. Before the ACA and Medicaid expansion, many of those people would have been unable to pay the hospital, which resulted in losses for the hospital, which in turn would be passed on to paying and insured patients. There’s no free lunch; eventually someone pays.
So, if the greater availability of local medical services can be traced to the ACA and Medicaid expansion, what happens when there are fewer Medicaid patients and people with insurance through the ACA exchanges? The answer is clear - medical providers have to retrench and tighten their belts. Augusta Health has already closed clinics, one in Buena Vista particularly, partly because they say they’re facing a loss of tens of millions of dollars from the projects reduction in Medicaid and ACAinsured patients. Other providers are certainly looking at how to cut costs, which could mean reduced services.
Lest we think that this is just a financial problem – a reallocation of national resources or some other sterile phrase – what we’re talking about is real people, sick people, people with chronic conditions like diabetes, going without health care. This is a human suffering issue.
This also affects people who have health insurance or are able to pay out of pocket. If a clinic near you closes, if there are fewer specialty clinics available locally, you’re going to have to drive farther to get the health care you need. You might have a longer wait time to get an appointment. Your medical condition could get worse.
For employers, it’s also a workforce issue. Healthy employees are more productive. They miss work less. They’re able to work harder and concentrate better.
The way we pay for and deliver health care in this country is so broken. We pay more for health care than any other country in the world, our health outcomes are mediocre and the inequity in health care delivery is, frankly, embarrassing. Fixing it would be a monumental undertaking, but other countries have made fundamental changes to their health care delivery systems. Their people pay less and get more. We should be able to do that, too. We just have to demand it of our leaders.
