By Dr. Eleanor Greene, MD, MPH
A recent study by the National Bureau of Economic research found that failure to close the coverage gap has led to nearly 16,000 unnecessary deaths across the remaining non-expansion states, including North Carolina.
As a physician, I do not want to just focus on numbers. Each number is a human life, lost too soon– a mother, daughter, sister, brother, child and more. Had these people been able to access the care that they needed in a timely fashion, many would be alive leading productive lives today. They would still be here and able to enjoy spending time with friends and loved ones.
I see these patients in my office and I see their struggle to obtain needed care without insurance. In December 2018, I saw a delightful woman, a mother of two young adult sons. She was 48 years old and came to my office after a year of vaginal bleeding. I asked her why she waited so long before seeing a doctor. She said it was because she did not have insurance. I was disappointed but not surprised to learn that even though she worked every day and worked in a healthcare facility, she had no health insurance.
By the time my patient presented to my office, she had obtained insurance and then made an appointment to be seen. (Although I do not require that one has insurance in order to be seen). I literally cried after examining her and finding half of her cervix eaten away by cervical cancer. Of course, now that she had insurance, she would receive the care that she needed with a cost of $200,000-$400,000, but all of that care could not save her life. Had the cause of her bleeding been diagnosed and treated a year earlier, the cost would have been under $1,000 and she would be alive today.
She fought a brave fight but unfortunately, she passed away last summer, around 16 months after being diagnosed with stage 4 cervical cancer. This case is both sad and frustrating for me as a Gynecologist, because cervical cancer is one of the few cancers that can be prevented or cured with early diagnosis. And for those who would focus on the economic toll, as you can see in this case, prevention or early diagnosis and treatment would have saved our health care system far more than treating end stage cervical cancer.
I also had another woman diagnosed with uterine cancer, which is a more aggressive type of cancer than cervical cancer, around the same time as my prior patient. She had insurance and sought treatment immediately when symptoms presented and is still alive today.
Shortly after my patient died last summer, a 38-year-old woman came in after going to the Emergency Room for rectal bleeding. She was treated there for hemorrhoids and advised to follow up with her doctor. She continued to complain of bleeding after her visit to the ER, so I referred her to a Gastroenterologist.
Several months later, I received a note from the ER again that she had been back there for rectal bleeding. I called her to find out what the Gastroenterologist that I referred her to found. She told me that she was not seen because she was no longer working and had lost her insurance. My receptionist then got on the phone and started calling local gastroenterology offices, trying to get the patient in for an appointment. It took multiple calls and 45 minutes before a gastroenterologist said they would see a patient with no insurance. The office agreeing to see the patient offered a reasonable self-pay plan and the patient was immediately scheduled and went to her appointment.
A rectal mass was found. A colonoscopy and biopsy were done, and invasive stage 4 colorectal cancer was diagnosed. She was told that her condition was not curable but was treatable. She now qualifies for Medicaid and is now getting the care she needed months ago. Again, her care was “Too little and Too late.”
These are just a couple of tragic cases that I have seen in my small office over the past year while our state fails to act to close the coverage gap. Undoubtedly, these cases are being replicated many times over among the estimated 750,000 North Carolinians in the coverage gap.
Too much time has passed and too many lives of previously productive North Carolinians have been lost because people cannot get the healthcare they need when they need it. It is past time for our state to join the other 38 states and close the coverage gap. It makes economic sense and it is the humane and the right thing to do.
Dr. Eleanor Greene is a trained Obstetrician and Gynecologist, and founded her own practice at Triad Women’s Health and Wellness Center in High Point, NC where she currently focuses on gynecology.