Wound Care Access: Insurance Coverage and the Affordable Care Act
By Janet Wolfson, PT, CLWT, CWS, CLT-LANA
Our clients with wounds and lymphedema incur many expenses in dealing with their recovery or disease process. When the Affordable Care Act (ACA) was passed, it afforded coverage for care that was denied, paid out-of-pocket, or just didn't happen in the past. Most lymphedema garments were still not covered because of the lack of definition as Durable Medical Equipment covered by Medicare. The individual mandates' repeal would take billions of dollars off the US deficit but leave millions of folks without health insurance and, therefore, likely with poor-to-no health care. Eliminating pre-existing condition coverage would mean much sicker people making difficult choices among such things as food, rent, schooling, gas... and health care.
Insurance Coverage and Clinical Outcomes
Working in wound care, be it at a clinic, a hospital, in home care, or wherever, we have all seen the difference that access and affordability can mean. As an example, people with diabetes with poorly managed glucose control are subject to increased trauma to their vascular system, can have ill-fitting shoes, and inadequate foot care. Preventive care doesn't happen, and when the resultant diabetic emergency sends these people reluctantly to the emergency department (ED), many more problems are often found. The feet can have infection, overgrown nails that can't be trimmed at home, and calluses hiding infection. The brain is subject to these glucose peaks and valleys and so is less able to direct self-care. In the past, I have seen more expensive absorbent or waterproof dressings substituted with cheaper but also absorbent baby diapers and feminine hygiene pads. They cover the wound but don't come with the care a wound professional can provide. I'm sure many of us recall trying to find patients charitable care or donated bandage supplies. Other wound-related diagnoses such as trauma, venous disease, cancer, surgical sites, or skin diseases can leave people subject to less than adequate home remedies and often result in a visit to the ED.
Any time someone appears in an ED, law mandates that this person cannot be turned down for care because of inability to pay. Someone will pay. Either the patients themselves will pay the burdensome payments to the health system, or you and I will, through higher care costs passed on by the hospitals as they absorb costs from non-payment. This is how it had been done for decades before the ACA and before Medicare.
Importance of Health Insurance Coverage
I encourage you to have insurance coverage. Anyone can end up in the ED, even healthy people after an accident or an unexpected health emergency such as cancer, infectious disease, stroke, or heart attack. I strongly encourage you to let your elected officials know that you value health care for all and every diagnosis. I implore you to investigate each candidate's stance on health care reform before you vote (kindly register if you haven't already!). The care we can provide our patients and that we ourselves receive depends on it. Even the most advanced dressings and medications aren't worth anything if insurance doesn't cover them and the patient can't afford them.
Congressional Budget Office. Repealing the individual health insurance mandate: an updated estimate. 2017. http://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53300-i.... Accessed on July 12, 2018.
About the Author
Janet Wolfson is a wound care and lymphedema educator with ILWTI, and Lymphedema and Wound Care Coordinator at Health South of Ocala with over 30 years of field experience.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.