How Trumpcare affects this medical student


I’m a medical student. I spend every day of my life considering the well-being of my future patients, and the detrimental impact that various health care policy proposals will have. I’m not going to lie. The ACA has problems. It’s not perfect, and I won’t wave the flag and pretend it’s the greatest thing ever. The reality is that the ACA plans are often cost prohibitive. The lack of a truly enforceable individual mandate presents a problem. The lack of restrictions on insurance companies handed them a blank check. I’m not here to present myself as a hard-left or hard-right political affiliate. Rather, I’m pointing out the obvious reality of the situation. Does the ACA have problems that must be addressed? 100 percent — yes. Anyone with knowledge of the health care system can see that. The system was broken before the ACA. The health care system is still broken.

Which brings us to the bill that passed in the House. Everyone recognizes that we need some change, but what we really need in health policy are solutions. Is this bill a solution? Is this something that fixes the portions of the ACA that are broken?


I could spend hours going into why this is bad for my future patients but is that the best use of our time?

Instead, let me focus on why it’s bad for me. One patient. I’m a medical student, yes, but I’m also a Type 1 insulin-dependent diabetic. If I’m uninsured, my diabetes costs sit at $13,000 a year. (This is a hugely conservative estimate, does not take into account physician visits and assumes that I have no unforeseen costs associated with this condition.)

I did not choose to be a diabetic. This is not related to my lifestyle or dietary choices. This is a pre-existing condition that is entirely outside of my control. I currently reside in a state where schools are not able to offer insurance choices, and my best bet is Medicaid. (As I mentioned, the ACA plans are cost prohibitive.) The bill that passed the House massively restricts Medicaid and provides the very real possibility that I will not qualify. This means I will be left to utilize substandard means to manage my diabetes. I’ll be using those substandard means while trying to juggle the impossible and unpredictable schedule associated with medical school.

There’s been a lot of talk about risk and pre-existing conditions lately. There’s a reason your car insurance costs more if you’ve had seven car accidents. There’s an increased likelihood you’re going to be involved in a collision, and your insurance company might have to pay out money. Just like drivers, some patients are considered “high-risk.” These patients have a higher likelihood to need health care services, which means there’s an increased likelihood the insurance companies will have to spend money. As a diabetic, I swim in that high-risk pool. A pool that serves only to protect insurance companies, and does absolutely nothing for the patients placed there.

I recognize that insurance companies are not benevolent organizations. They are in the insurance business for one purpose only: to make money. While I am personally bothered by the behaviors of these companies, I understand what they’re doing. More to the point, I can’t necessarily say that I would do anything differently if I were in that business. However, we’re not really talking about the insurance companies’ behavior, are we? We’re talking about the United States government. The United States government is not a business. It is not a part of the insurance game. It is a government tasked with the sole purpose of serving and protecting its citizens.

The simple truth is placing patients in a high-risk pool does not protect citizens. It protects insurance companies. It does not increase the coverage I will receive. It does not mean I will pay less for the insulin that I need to live. It does not mean I will have increased access to continuous glucose monitoring systems that will lead to fewer costly side effects in the years to come. It means I will pay higher premiums, for fewer benefits. Premiums that I cannot afford. I have no income as a medical student because learning to treat patients is a full-time job and then some. It means I will be using insulin therapy that doesn’t provide ideal control because it is my cheapest option.

It means I will not go to the doctor because I cannot afford to. I will not get my yearly eye exam. I will not see my endocrinologist four times a year. I will not see a physician when I feel ill, and I will gamble that I won’t be hospitalized. I’ll make that gamble because I cannot possibly cover the cost of a hospital visit. It means that if I am hospitalized, I will not have the means to cover the increased cost of treating a diabetic patient. The cost burden of that care will be spread across other patients (you), and your health care services will become more expensive. It means that, as a future physician, I will not be following “doctor’s orders.” Not because I’m ignorant, not because I think I’m bulletproof, but because I simply cannot afford to pay.

I am not a health care policy specialist. I don’t have the perfect answer. I don’t have the solution. I am under no illusions that this topic is incredibly above my pay grade. I am, however, one of the patients that this bill directly affects. If benefits decrease and costs increase, my health will suffer. More importantly, there’s a very real possibility that yours will as well. Please be educated, please learn and please vote.

John Rajala is a medical student.

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