Back in September 2013, I met with first year medical students at the University of Chicago Pritzker School of Medicine to discuss the ethics of student run free clinics. What could first year students ethically contribute to patient care in free clinics—when they hadn’t even learned how to listen to a heart yet and every pertinent question they asked would have to repeated with an attending? In the discussion, I shared the argument that the most ethical thing first year medical students could be doing in the clinics was getting patients OUT of the clinics. Patients connected to health insurance could get ongoing care with a dedicated provider.
Students at the University of Chicago Pritzker School of Medicine decided to take on the challenge of connecting patients with health insurance. A team led by MS2 Lauren Hobbs and MS1 Margaret Wang took on the task of preparing to train medical students to teach patients about their health insurance options. Along with Loyola law student Rachelle Sico, they supported the creation and dissemination of a pocketcard on Screening for Health Insurance Status. Loyola University medical student Aaron Silver was the main creator of the card, with content and editing support from internist Dr. Ram Krishnamoorthi, and myself.
It is an awesome card that I am proud to be able to share with healthcare providers.
The card is broken into four segments:
1. Why is insurance important?
2. How do you screen?
3. Frequently asked questions about the Affordable Care Act
4. Income qualification table for Medicaid and subsidies
1. Being uninsured or underinsured puts you at increased risk of bankruptcy, stress, and death from cancer. Over 50% of personal bankruptcies are from medical costs. People without health insurance are five times more likely to die from cancer. Not having health insurance slows specialty appointments and expensive imaging, delaying care. An estimated 26,000 people die each year from a lack of health insurance.
2. Health care providers can screen with a series of three simple questions: do you have health insurance? Are you happy with what it covers? Are you happy with the cost? A no answer to any of these means you should recommend patients check out their options either on the federal or state exchanges. Healthcare.gov, or in Illinois, GetCoveredIllinois.gov. They can also call hotlines to find out how to get connected to a navigator. In Illinois, 1-866-311-1119.
3. Pretty much everyone must have coverage by March 31, 2014 or pay a fine. The exceptions are undocumented immigrants, and people who are too poor to qualify for subsidies on the exchanges in the states where Medicaid did not expand. About half the states did expand Medicaid. You can check on healthcare.gov if yours did. On the exchanges, patients can buy bronze, silver, gold or platinum plans, with different co-pays and deductibles. No matter what the plan, no individual needs to pay more then $6350 each year on out-of-pocket in-network medical costs, and for families no more than $12,700.
4. As for income qualifications: lots of people qualify for subsidies. Medicaid covers people up to 138% of the poverty line (up to approximately $15,000) except in the states that did not expand Medicaid coverage. People who are making up to four times the federal poverty line receive subsidies. To sign up, people must have proof of their last year’s income and proof of their identity with a social security number.
The goal is to make checking health insurance status a routine part of every clinic visit, getting as many people signed up as possible in the next two months.
Social History: Do you smoke? Drink? Have health insurance? Are you happy with what it covers, and the cost?
We introduced the Health Insurance Status Screening pocket cards to about 30 medical students on a Monday. On Thursday, student organizer Lauren sent the following message:
Just wanted to let you know that one of the MS1s ran up to me today to tell me that she used the pocket card with a pregnant patient with several health complications who is totally eligible for coverage but didn't have any. Quote:
"The card works just like you said. I called the number and now a Navigator is coming to the shelter next week! They know so much. I'm really glad that you had that meeting"
Good work team! We made a difference :)
I believe the students are making a difference. And I encourage you to also—whether you’re a student or a practicing physician, check out the card, familiarize yourself with the basics, start screening your patients for health insurance status and refer them to healthcare.gov no matter what state you are in, and train your colleagues to do the same.
We can make a difference in patients’ lives, providing the most ethical care possible by connecting them with the health insurance they need.