This week’s blog topic is: What factors determine who has access to healthcare, and who may not. There are many factors that can play a role into who is able to access healthcare such as transportation methods and number of hospitals in the area. However, I discussed both of those topics in my blog last week. New Jersey is able to get people to their medical appointments via 150 public buses and 11 major rail lines, and NJ access link. There are numerous hospitals where I live. The factor that impacts a patient’s access to healthcare that I would like to discuss this week is the financial factor. 

As I discussed last week, Wayne has 5.5% of people under age 65 that are uninsured, and Paterson has 19.5% of people under age 65 that are uninsured. Let us first look at the group of people that are insured. Those with insurance are able to schedule appointments with primary care doctors and specialists as long as the doctor is in the insurance network. The biggest issue for people that have insurance is that some doctors do not accept certain insurances. I would like to focus on those with no insurance as they are faced with many tough decisions. 

Paying for Healthcare With No Insurance 

In The US, you cannot be turned away due to EMTALA, which ensures public access to emergency services regardless of ability to pay. Oftentimes, patients will let their health issues build up until they can no longer take it, because they cannot afford care elsewhere. Then they will go to the emergency room because they cannot be turned away there. This is a very dangerous game that these patients are being forced to play. If someone with a cardiac issue is putting off care, they do not know when that big heart attack is coming because they are not able to pay to see a doctor. When patients do finally go to the emergency room, they will get a big bill. This is where NJ Family Care will help them out. “NJ Family care includes: children, pregnant women, parents/caretaker relatives, single adults and childless couples. Financial eligibility will be determined by the latest federal tax return which, when filed, will be electronically verified.” To be more specific parents/ caretakers are eligible for coverage “with income up to 138% FPL ($3,013/month for a family of four) and must have tax dependent children in their household in order to be eligible under this category.” This allows patients to get financial help for their much-needed medical procedures. Another alternative to waiting to go to the emergency room is to take advantage of a free medical clinic. In Paterson one such clinic is the Paterson Community Health Center. The Paterson Community Health Center provides medical and dental care at little to no charge. 

COVID Payment In Wayne

I would like to turn to the COVID-19 pandemic in my area, and how it has amplified the issue of patients not being able to pay for healthcare. The number of cases in Wayne went up to 1,001 (from 964), and Paterson went up to 5,115 cases (from 4,751). I would now like to discuss an issue I posed at the end of last week’s blog: How are all of the uninsured people in Paterson going to pay for COVID-19 treatment. COVID-19 Treatment is very expensive. Being on a ventilator costs about $400 a day. Studies are showing that COVID-19 treatment can cost upwards of $30,000. In order to cope with this, New Jersey’s Governor Phil Murphy requested that the federal government open a Special Enrollment Period (SEP) in New Jersey to allow uninsured and underinsured residents to enroll in health coverage through the federal health insurance exchange “Therefore, as New Jersey transitions from a State Based Exchange on the Federal Platform to a State Based Exchange, I respectfully urge the Administrator of the Centers for Medicare & Medicaid Services to authorize a Special Enrollment Period in New Jersey to allow individuals to access affordable health insurance options through the federal platform.” This allows patients that do not have insurance to get the treatment they need. While doing research, I found that, “Health insurers Cigna and Humana are now waiving patient cost-sharing on all treatment for coronavirus, including hospitalizations and ambulance transfers, for their insured members and employer plans.” It is good to see that both people who are uninsured and insured are being given a break during this pandemic.

National COVID Payment Plan and The Future 

But how are hospitals paying for the treatment of those uninsured patients? The answer is that President Trump set up a $100 billion fund to reimburse hospitals and other health care providers for their coronavirus expenses. This is great for the current situation we are in, but what happens when we go back to a “normal” life. Are the patients in Paterson who are being treated for free now, still going to be treated for free in the future? Or are they going to have to wait to get treated in an emergency room because they cannot afford care until then.