Obamacare and the ER

at 10:43 PM

As a physician, people often assume that I know a lot about health insurance and the business side of medicine. But I don't. It wasn't part of my medical training. I spent those years learning anatomy and physiology, and how to be at the bedside, treating my patients.

I work in the Emergency Room now. You can tell a lot about what is going on in your community by the look of the waiting room. I trained in Oakland at a county hospital. In the years before the Affordable Care Act, our ER waiting room was filled with uninsured patients who would have been better off at a primary care physician's office. They had a new breast lump, worsening back pain, frequent headaches, or an infected pimple. These were important complaints that represented potentially life-changing conditions, such as possible breast cancer, a herniated disc, or new migraines requiring trials of medications and referral to a headache specialist. These patients regularly waited as long as 12 hours in the waiting room, to be seen by me - an ER physician, who didn't know them, would likely never see them again, and often couldn't arrange for the specialty care referrals, or continuity of care, that must come from a primary care physician.

Several times a day I would ask myself, "Why is this person in the ER?", and the answer was always the same: "They have nowhere else to go." The ACA changed all that, dramatically. Our waiting room is no longer bursting with patients with primary care needs. The majority of patients I see actually need emergency services - emergent imaging studies, IV fluids, antibiotics, or admission to the hospital. I find myself asking "Why is this person in the ER?" less and less.

With repeal of the ACA imminent, I think of our waiting room returning to the way it used to be. That wasn't good for patients, for physicians, or for whoever was ultimately paying the bill. I still don't know a lot about the business side of medicine. But I know my waiting room. And I know that a repeal of the ACA will lead to more uninsured people, and more ER crowding by patients who actually need access to timely and high-quality primary care.

And that's not a good or safe idea.

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With a Perspective, I'm Dr. Aparajita Sohoni.

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Dr. Aparajita Sohoni lives in Oakland and practices emergency medicine in San Francisco.

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