Department of Medicine

University of Pittsburgh

GIM News
Donna L. Bishop, Editor

Next issue:
December 2014

Submission deadline:
November 14, 2014


Affordable Care Act and the Birmingham Free Clinic – A Personal Story

By Thuy Bui, MD, PHCUP/Birmingham Clinic Medical Director

Our Birmingham Free Clinic (BFC) staff has been asked if we are experiencing changes with the decreasing number of uninsured Americans since the start of the Affordable Care Act (ACA) enrollment period last fall. It would be amazing if the BFC did not have any patients—meaning everyone would be insured and satisfied with the care they receive!

A recent BFC patient of mine, Rose, shared her ACA enrollment experience with me, a story that exemplifies that the road to health insurance could be a bumpy ride. Until June 2013, Rose had employer-sponsored health insurance through Cigna. She was disappointed with the coverage, especially for prescriptions. Access to medications for her diabetes, hypertension, and heart problem is vital for her health; however, she could no longer afford her insurance when the cost went up last year. She decided, “If I’m going to pay more, I should get better coverage.” After talking with a friend, she realized she could purchase coverage through the national exchange because her share of the premium for employer-sponsored coverage exceeded 9.5% of her adjusted gross income.

Rose called the number on the website soon after the start of the open enrollment period. She selected a Highmark Community Blue plan because of its low monthly premium.

In December of 2013, Rose established care at the BFC, but we did not expect her to return. With hope and optimism, she told our staff that she had signed up for the ACA and would receive coverage effective in January 2014. She explained that she only needed this one visit with us to hold her over until she would be insured once again.

Once Rose received her new insurance card, she returned to the primary care provider she previously saw at Allegheny General Hospital for care and received prescriptions for all her medications. When she went to the pharmacy to pick up her prescription, she was dismayed to learn that her insulin alone would cost $300 out of pocket because she had not met her deductible of $1,500. She became despondent at the thought of going off insulin. The other medications she could afford through the $4 Giant Eagle discount; however, after losing her job in June of 2014, she was not able to afford the insulin.

Rose returned to the BFC this month. When we asked what transpired in the past six months, we learned of her heartbreaking story. She received Lantus and Novolog insulins through pharmaceutical manufacturers’ assistance programs initiated by our pharmacists and AmeriCorps volunteers. Lisinopril, atenolol, and simvastatin were dispensed from our modest stock of commonly used generic medications. Rose is again looking for employment, hoping that the next employer will offer more generous benefits.

Rose, like many others Pennsylvanians, has been affected by Pennsylvania’s decision to not expand Medicaid. As of July 2014, this decision continues to contribute to the coverage gap by preventing nearly 300,000 adults in Pennsylvania from benefiting from the new health law—a decision that disproportionately affects people of color as well as the majority of low-wage workers. It is estimated that the ACA might be responsible for more than 9 million uninsured persons gaining health insurance; however, many more remain uninsured. Patients like Rose will still struggle each month, juggling between the costs of everyday essentials and health care expenses, such as medications. For Rose and so many others, the BFC will continue to provide a safety net supported by the generosity of Division support, our many volunteer providers, students, and donors.