By Kennedy Williams
Navigating the healthcare system as a patient can be extremely tough, a combination of understanding medical jargon, lack of personal relationships with doctors, and unforeseen costs. Many patients share these similar feelings, especially, when it is time to pay for the treatments, appointments, and medications. These unforeseen costs continue to rise especially for patients who are not insured and must pay for everything out of pocket. For many patients in this circumstance, it creates a relationship with the United States Medical System that revolves around uncertainty and scarcity. Today, there are 31 million Americans navigating the healthcare system without insurance (Stasha). The lack of insurance creates many roadblocks, barriers, and hardships that they must jump through to receive basic care. These barriers create a chain reaction that trickles down to every aspect of the healthcare system, especially the in reproductive healthcare system.
When a patient does not have access to affordable clinics, it causes them to look elsewhere for treatment, sometimes those being home remedies. In the Stores to Save Lives Interview Database, Mederna Bennet, a Medical Case Manager, discusses her battles with insurance and how she felt relief at college when they covered her insurance. She discusses numerous home remedies she would partake in to negate going to the doctor. For example, she would drink “tea all the time” or place “rice socks on” her “sore cramps” (Bennet). This is only one of the many examples in the SSL that discusses home remedies to replace visiting the doctor. To think that Bennett was experiencing painful cramps which are not normal and had to turn to things in her home because she could not afford to seek treatment reflects what many Americans face on a daily basis as well. Many more Stories to Save Lives Interviews discussed home remedies, for example, George Cosmos discussed how his patients “had different home remedies that she would try…” such as “aloe vera or turmeric” (Cosmos). Or Barbara Brayboy, Tammy Blackman, Ruth McKeithan, just to name a few. However, when the home remedies do not work, patients must seek treatment at affordable clinics or emergency care at hospitals.
For patients seeking healthcare services without insurance, a typical appointment can turn into three or four hours. This large range of one’s untypical appointment is based on the patient having to cram several different preventative services into one appointment. This can be because patients cannot afford another appointment or because a patient did not have access to care and finally have access to an affordable clinic. Writing in the Journal of Community Health, Eileen Wang, Chole Getrajman, Gabriela Frid, Japjot Bal, Cynthia Abraham, Adam Jacobs, Yasmin Meah, and Frida Nentin, an account of physicians discussing their experience while working at a student-ran clinic in East Harlem, they state, “uninsured women are less likely to utilize preventative health services in general and more likely to utilize emergency care compared to women with insurance” (Wang). This quote creates an understanding that for many patients who do not have insurance, they are more likely to wait until an issue with their body has become long-term or fatal before choosing to receive emergency care. The article provides an in-depth look into what an appointment for each patient reflected, and how many times patients are being seen for “multiple problems” that “can involve prolonged and/or multiple procedures” entirely in one visit. Sometimes at these check-ups, patients and physicians have discovered that a patient has waited too long to seek preventative treatment, they often have untreated diseases or disorders that wreak havoc on their reproductive systems. They stated, “In addition, a substantial number of them reported a history of IPV, which is associated with physical health consequences including sexually transmitted infections, vaginal bleeding, pelvic pain, and dyspareunia” (Wang). When a patient has waited too long to seek medical services, their issues can turn into much larger problems. A prime example of waiting too long to seek medical services, is sexually transmitted diseases like the Human Immunodeficiency Virus or Chlamydia.
For Stephanie Atkinson, a CommWell Health employee, she witnessed first-hand, how difficult it was for patients to navigate the healthcare system with sexually transmitted diseases. Especially, seeing how waiting too long allowed for the progression of a patient’s HIV to turn into an AIDS diagnosis. The Human Immunodeficiency Virus strains a person’s body, wreaks havoc on their immune system, and mentally takes a toll on them. So, for patients diagnosed with HIV, navigating changes in their body, and navigating treatment is terrible combination that often leads patients without treatment. Atkinson believes for a main reason for patients not seeking treatment for HIV is due to the fact that they “grew up in a time where people just didn’t go to the doctor because they couldn’t afford it” (Atkinson). These mindset results in patients who are “really sick” and “not only diagnosed with HIV, but sometimes they’ve also been diagnosed with AIDS” (Atkinson). Another reason Atkinson believes patients do not seek treatment for HIV is due to a prevalent connection between patients who are uninsured, and who are not aware of the available resources. Those resources being affordable appointments, transportation, affordable medication, counseling, and referrals to specialists. There are numerous reasons for patients not being able to seek treatment, however, the biggest result of not seeking treatment is being left with long-term disorders that effect other organs and systems in the body.
A common effect of not seeking treatment for sexually transmitted diseases is infertility, and to seek fertility treatment while uninsured is extremely difficult. In the American Medical Association Journal, Dr. Iris G. Insogna and Dr. Elizabeth S. Ginsburg discuss the current state of insurance coverage for fertility treatments and how this affects patients when seeking treatment. Currently, under the Affordable Care Act, “there is no coverage for infertility treatment for patients with public or federal insurance” (Insogna). This means that patients insured under the Affordable Care Act must seek fertility treatments out of pocket. The physicians note that this same concept applies for employees of the Federal government because lawmakers deem it as a “controversial issue” (Insogna). Even for patients, who did seek treatment and pay out of pocket, there are more roadblocks in place from physicians who are not willing to take them on as patients or those who do provide services, but only the basic services. A common disorder that stems from untreated “sexually transmitted diseases and ectopic pregnancies” is tubal factor infertility. (Insogna). There are various ART treatments or assisted reproductive technology treatments performed by physicians to reverse the effects of those untreated reproductive disorders. However, in their study, Dr. Insogna and Dr. Ginsburg found that “physicians practicing in states without an insurance mandate were more likely not to perform salpingectomy or proximal tubal occlusion before providing ART due to lack of infertility insurance coverage” (Insogna). This means that patients who did not have insurance were more likely to receive below standard care which decreasing their chance of having high outcomes of success with conceiving after fertility treatments. This means that in thirty-three states must find alternatives way to cover fertility treatment or cannot seek treatment at all.
The healthcare systems relationship with patients who are uninsured creates hardships, barriers, and life-long effects on their well-being. As technology grows, patients are becoming more aware of resources available, and ways to navigate throughout the healthcare system. However, this change in resources has come too late for some patients, in Dead Man Walking, a text written by Michael Stillman and Monalisa Tailor, they encounter a patient who could not afford to seek medical treatment and unknowingly had metastatic colon cancer. This story is far too common in the system, patients have not had access for quite some time, and as a result the progression of deadly diseases has wreaked havoc on their body. Accessing healthcare should not be this difficult, it should be easy for all patients of every race, gender, and ethnicity. As the Deceleration of Independence states, man has “unalienable rights to life, liberty, and the pursuit of happiness” Is the healthcare system upholding these rights?
Atkinson, Stephanie. Interview with Maddy Kameny. June 2018 (Y-0003). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Bennett, Merenda. Interview with Joanna Ramirez. June 2018 (Y-0009). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Cosmos, George. Interview with Darius Scott. June 2018 (Y-0015). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Insogna, I. G., & Ginsburg, E. S. (2018, December 1). Infertility, inequality, and how lack of insurance coverage compromises Reproductive Autonomy. Journal of Ethics | American Medical Association. Retrieved March 3, 2022, from https://journalofethics.ama-assn.org/article/infertility-inequality-and-how-lack-insurance-coverage-compromises-reproductive-autonomy/2018-12.
Stasha, Smiljanic. “Uninsured Americans Stats and Facts 2021: Policy Advice.” PolicyAdvice, Policy Advice, 5 Mar. 2022, policyadvice.net/insurance/insights/how-many-uninsured-americans/.
Wang, E., Getrajdman, C., Frid, G. et al. A Three-Year Analysis of the Impact of a Student-Run Gynecology Clinic on Access to Reproductive Health Care for Uninsured Women in East Harlem. J Community Health 46, 1132–1138 (2021). https://doi.org/10.1007/s10900-021-01001-3.