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Obamacare hasn’t solved the challenge of uninsured patients


It will cost a lot to solve the challenge of covering the 30 million Americans who are still uninsured despite the Affordable Care Act.

It will cost a lot to solve the challenge of covering the 30 million Americans who are still uninsured despite the Affordable Care Act.

First, I would hope that we all agree that no one in the United States should be uninsured and that the cost of covering the uninsured is our biggest challenge. There are arguments about the astronomical cost of expanding government programs like Medicaid and Medicare and offering government subsidies of premiums but I haven’t heard a more convincing argument than doing just that.


Related: Will Republican proposals to replace Obamacare make America healthier?


Many of us are convinced we’re paying higher premiums to cover the cost of those without insurance,  but I don’t mind it in order to help those in need.  

Some of those who are fortunate or self-made say, “If I did it, why can’t everyone else?” As much as the “haves” want to believe it wasn’t circumstance or luck that got them where they are, it was.  It was also genes and chance that kept them from being a “have-not.” 

Maybe our country is suffering from “compassion fatigue.” Or perhaps we have what Ronald Reagan referred to as a “selfish populous.”  

I’ve heard many proposed solutions to support universal coverage but I’m not convinced any are sufficient to address the problem. Creating jobs is one solution that we all probably agree would eventually lead to more health coverage.  This is likely the best solution; it helps people help themselves. It may help the unemployed portion of the 30 million people find work and another portion may already be working yet not insured.   

Legislation has been proposed that would allow the undocumented to purchase healthcare insurance without subsidies, but I’m not sure how many could afford it. Even under low-cost, less comprehensive plans not allowed under the ACA, families would still likely be left with large uncovered costs. There are tax credits, refunds and tax-deductible health savings plans but many people can’t afford to save because they’re living paycheck to paycheck or won’t save unless they’re forced to.

Next: 'I challenge all healthcare professionals to do your part'


Some companies are allowing employees to cover children over age 26 and other family members such as parents.  This seems reasonable but I’d imagine it raises costs for the employer.

It has been proposed as part of the new Republican anti-poverty plan that current welfare to work requirements should be expanded. Many of those receiving government assistance would like to work but have other challenges such as childcare, transportation and even stable housing.


Further reading: Obamacare is severely holding DPC back from succeeding


As a pediatrician, my heart smiles now that California has decided to cover all children under Medicaid who are in need and passed legislation to investigate allowing anyone who lives here to purchase healthcare insurance regardless of legal status. But I suffer a bit every day knowing there are millions of children and families who need care and aren’t getting it, in the country we consider the greatest in the world.

I challenge all healthcare professionals to do your part.  Speak up, get into the discussion and help solve this challenge. All of us deserve to be cared for, and who is better than healers, to find the most humanitarian solution possible?  


Maria Chandler, MD, MBA, is a pediatrician, clinical professor at the University of California, Irvine, president of the Association of MD/MBA Programs, and member of the Medical Economics Editorial Advisory Board. How should doctors respond to the problem of uninsured patients? Tell us at medec@advanstar.com.

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