As reports of the first US case of Ebola percolated through the U.S. media, many media outlets jumped all over themselves to second-guess the Dallas hospital that initially treated Patient X. Initial reports indicated that no one had asked him his travel history when he initially presented to the hospital ER. Subsequent reports appear to confirm that he was indeed asked, that he replied he was visiting from Liberia, but that this information was not properly "communicated" through the chain of command at the hospital.
But let's forget for a moment whether Texas Health Presbyterian Hospital did or did not ask Patient X (now identified as Thomas Duncan of Monrovia, Liberia) about his travel history. Let's even forget that the fact that he first sought treatment in the ER strongly suggests he didn't have any health insurance (which would put him among good company with other Texas residents).
Instead, let's just imagine that he didn't go to the hospital at all.
Health providers can choose to not provide care to the uninsured. Only emergency departments are required by federal law to screen and stabilize all individuals. However, the uninsured are not necessarily more likely to use the emergency room than those with insurance.15 If the uninsured are unable to pay for care in full, they are often turned away when they seek follow-up care for urgent medical conditions.
In this case something--we don't know what--prompted Mr. Duncan to seek immediate medical treatment. However he might just as easily have decided to "tough it out' like millions of other low-income Americans do and wait for whatever was making him sick to get better (hopefully). When your choice is between paying for food or rent rather than going to the doctor, it's not a difficult decision. And you still go to work.
The uninsured report higher rates of postponing care or forgoing needed care or prescriptions due to cost compared to those enrolled in Medicaid and other public programs. A seminal study of health insurance in Oregon found that the uninsured were less likely to receive care from a hospital or doctor than newly insured Medicaid enrollees.23 A follow-up study found that newly insured Medicaid enrollees were much less likely to delay care because of costs than the uninsured.24
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sources omitted)
In Texas, like many other states dominated by Republican governors and legislatures, nearly eight million people remain uninsured, unable to afford health insurance but with an income too high to qualify for Medicaid. That is what the Affordable Health care sought to correct, but thanks to the Supreme Court states were allowed to opt out of the ACA provisions that expanded Medicaid coverage. Texas' Republican governor Rick Perry chose to opt out, leaving thousands of people uninsured as a consequence.
Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help.
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Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.
A study by the Kaiser Family Foundation found that the uninsured are
twice as likely to forego medical treatment as those who have insurance. A Gallup survey found that 3 in 5 Americans without insurance
forego appropriate health care due to cost concerns.
As of this writing 12-18 people (presumably all Texas residents) have been identified as coming into contact with patient X, including five schoolchildren. There's no hard data yet on how many people they came into contact with (current estimates top out at 100 thus far), or how many are uninsured.
How many of them did Rick Perry leave uninsured, to fend for themselves, refusing to see a doctor until it's too late? And what will be the consequences of that?